STUDY AID
P S Y C H I AT R I C - M E N TA L H E A LT H N U R S I N G · E X A M R E V I E W & S T U D Y B A N K
NR 547 Differential Diagnosis in
Psychiatric-Mental Health
Midterm Complete Review Bank
Exam Review Edition · Questions, Answers & Rationales
50 Questions Full Rationales Answer Key Included
50 5 100%
QUESTIONS SECTIONS R AT I O N A L E S
WHAT THIS COVERS
01 Diagnostic Reasoning and Case Formulation
02 Depressive Disorders and Differential Diagnosis
03 Anxiety, Trauma, and Obsessive-Compulsive Disorders
04 Psychosis Spectrum and Neurodevelopmental Differentials
05 Substance-Related Presentations and Medical Mimics
ABOUT THIS ASSESSMENT
This study bank contains 50 original, scenario-based multiple-choice questions focused on the highest-yield topics of the
course.
Every stem, option, and rationale was written specifically for this edition and reviewed for accuracy, clarity, and
one-best-answer construction.
The rationales explain why the keyed answer is correct and why the strongest distractor is wrong, so every item teaches as
well as tests.
This document is an original study aid intended for personal educational review only.
It is not the actual examination of any institution and is not affiliated with or endorsed by any school, program, or testing
body.
75% () Application / Analysis 50 MCQs · PDF
PA S S I N G S C O R E LEVEL F O R M AT
EXAM REVIEW & STUDY BANK · 2026/2027 Page 1
,NR 547 Differential Diagnosis in Psychiatric-Mental Health · Midterm Review Bank Edition
SECTION 1 · DIAGNOSTIC REASONING AND CASE FORMULATION
Q1. An 82-year-old woman is admitted for a urinary tract infection. On hospital day two she becomes
inattentive and disoriented, sees children in the room at night, and is lucid again by morning; her
family insists this is dementia that began this week. What is the correct diagnostic priority?
A. Start a cholinesterase inhibitor for the new onset of dementia
B. Diagnose major depressive disorder and begin an antidepressant
C. Refer for home safety evaluation assuming normal aging changes
D. Evaluate and treat delirium and the acute medical cause before considering dementia
Correct Answer: D
Rationale: Acute onset with fluctuating attention and perceptual disturbances during an active infection is delirium
until proven otherwise. Dementia produces chronic, insidious decline, and neither depression nor a home evaluation
explains the fluctuating encephalopathy.
Q2. A 44-year-old attorney presents six weeks after being demoted. He reports low mood most days and
difficulty sleeping two to three nights per week, but he continues to work, enjoys his weekend
cycling, and denies worthlessness or hopelessness. Which diagnosis best fits this presentation?
A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Persistent depressive disorder
D. Bipolar II disorder, current depressed phase
Correct Answer: B
Rationale: Symptoms began within three months of an identifiable stressor, cause distress, yet never meet the
five-symptom threshold for major depression. Persistent depressive disorder requires two years of symptoms, and no
manic or hypomanic history is described.
EXAM REVIEW & STUDY BANK · 2026/2027 Page 2
, NR 547 Differential Diagnosis in Psychiatric-Mental Health · Midterm Review Bank Edition
Q3. A primary-care patient completes a PHQ-9 and scores 14, describing six weeks of depressed mood
and low energy that interfere with daily tasks. There are no safety concerns and no history of mania.
What is the most appropriate next step?
A. Arrange same-day psychiatric hospitalization for severe symptoms
B. Adopt watchful waiting for six months without scheduled follow-up
C. Initiate first-line treatment and repeat the PHQ-9 in four to six weeks
D. Diagnose bipolar depression and start a mood stabilizer instead
Correct Answer: C
Rationale: A PHQ-9 of 14 reflects moderate depression appropriate for outpatient first-line treatment with
structured re-measurement at four to six weeks. Hospitalization is reserved for imminent danger, and there is no
hypomanic history to justify bipolar treatment.
Q4. A nurse practitioner plans to start fluoxetine for a 16-year-old with moderate depression. Before
writing the prescription, which assessment action is required to establish a safe baseline?
A. Administer a structured suicide-risk screen such as the Columbia protocol
B. Skip formal screening because the depression is only moderate
C. Begin the medication and schedule the first risk review in three months
D. Exclude antidepressants entirely because of the adolescent age group
Correct Answer: A
Rationale: Antidepressant labels carry a boxed warning for suicidality in patients under 25, so a structured baseline
risk assessment is essential before starting treatment. Moderate severity does not remove the need for screening, and
fluoxetine remains a first-line adolescent option when monitored.
Q5. A 68-year-old woman with no psychiatric history presents with three months of depressed mood,
fatigue, constipation, and an eight-pound weight gain. Before confirming a primary depressive
disorder, which action is most clinically sound?
A. Start a therapeutic SSRI dose immediately and reassess in one year
B. Order TSH, CBC, metabolic panel, and vitamin B12 to exclude medical mimics
C. Attribute the symptoms to normal aging and provide reassurance
D. Refer directly for electroconvulsive therapy given the somatic profile
Correct Answer: B
Rationale: New-onset depression in an older adult warrants laboratory evaluation because hypothyroidism, anemia,
and metabolic abnormalities can reproduce the syndrome. Treating a reversible medical cause first prevents years of
unnecessary psychiatric medication.
EXAM REVIEW & STUDY BANK · 2026/2027 Page 3
P S Y C H I AT R I C - M E N TA L H E A LT H N U R S I N G · E X A M R E V I E W & S T U D Y B A N K
NR 547 Differential Diagnosis in
Psychiatric-Mental Health
Midterm Complete Review Bank
Exam Review Edition · Questions, Answers & Rationales
50 Questions Full Rationales Answer Key Included
50 5 100%
QUESTIONS SECTIONS R AT I O N A L E S
WHAT THIS COVERS
01 Diagnostic Reasoning and Case Formulation
02 Depressive Disorders and Differential Diagnosis
03 Anxiety, Trauma, and Obsessive-Compulsive Disorders
04 Psychosis Spectrum and Neurodevelopmental Differentials
05 Substance-Related Presentations and Medical Mimics
ABOUT THIS ASSESSMENT
This study bank contains 50 original, scenario-based multiple-choice questions focused on the highest-yield topics of the
course.
Every stem, option, and rationale was written specifically for this edition and reviewed for accuracy, clarity, and
one-best-answer construction.
The rationales explain why the keyed answer is correct and why the strongest distractor is wrong, so every item teaches as
well as tests.
This document is an original study aid intended for personal educational review only.
It is not the actual examination of any institution and is not affiliated with or endorsed by any school, program, or testing
body.
75% () Application / Analysis 50 MCQs · PDF
PA S S I N G S C O R E LEVEL F O R M AT
EXAM REVIEW & STUDY BANK · 2026/2027 Page 1
,NR 547 Differential Diagnosis in Psychiatric-Mental Health · Midterm Review Bank Edition
SECTION 1 · DIAGNOSTIC REASONING AND CASE FORMULATION
Q1. An 82-year-old woman is admitted for a urinary tract infection. On hospital day two she becomes
inattentive and disoriented, sees children in the room at night, and is lucid again by morning; her
family insists this is dementia that began this week. What is the correct diagnostic priority?
A. Start a cholinesterase inhibitor for the new onset of dementia
B. Diagnose major depressive disorder and begin an antidepressant
C. Refer for home safety evaluation assuming normal aging changes
D. Evaluate and treat delirium and the acute medical cause before considering dementia
Correct Answer: D
Rationale: Acute onset with fluctuating attention and perceptual disturbances during an active infection is delirium
until proven otherwise. Dementia produces chronic, insidious decline, and neither depression nor a home evaluation
explains the fluctuating encephalopathy.
Q2. A 44-year-old attorney presents six weeks after being demoted. He reports low mood most days and
difficulty sleeping two to three nights per week, but he continues to work, enjoys his weekend
cycling, and denies worthlessness or hopelessness. Which diagnosis best fits this presentation?
A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Persistent depressive disorder
D. Bipolar II disorder, current depressed phase
Correct Answer: B
Rationale: Symptoms began within three months of an identifiable stressor, cause distress, yet never meet the
five-symptom threshold for major depression. Persistent depressive disorder requires two years of symptoms, and no
manic or hypomanic history is described.
EXAM REVIEW & STUDY BANK · 2026/2027 Page 2
, NR 547 Differential Diagnosis in Psychiatric-Mental Health · Midterm Review Bank Edition
Q3. A primary-care patient completes a PHQ-9 and scores 14, describing six weeks of depressed mood
and low energy that interfere with daily tasks. There are no safety concerns and no history of mania.
What is the most appropriate next step?
A. Arrange same-day psychiatric hospitalization for severe symptoms
B. Adopt watchful waiting for six months without scheduled follow-up
C. Initiate first-line treatment and repeat the PHQ-9 in four to six weeks
D. Diagnose bipolar depression and start a mood stabilizer instead
Correct Answer: C
Rationale: A PHQ-9 of 14 reflects moderate depression appropriate for outpatient first-line treatment with
structured re-measurement at four to six weeks. Hospitalization is reserved for imminent danger, and there is no
hypomanic history to justify bipolar treatment.
Q4. A nurse practitioner plans to start fluoxetine for a 16-year-old with moderate depression. Before
writing the prescription, which assessment action is required to establish a safe baseline?
A. Administer a structured suicide-risk screen such as the Columbia protocol
B. Skip formal screening because the depression is only moderate
C. Begin the medication and schedule the first risk review in three months
D. Exclude antidepressants entirely because of the adolescent age group
Correct Answer: A
Rationale: Antidepressant labels carry a boxed warning for suicidality in patients under 25, so a structured baseline
risk assessment is essential before starting treatment. Moderate severity does not remove the need for screening, and
fluoxetine remains a first-line adolescent option when monitored.
Q5. A 68-year-old woman with no psychiatric history presents with three months of depressed mood,
fatigue, constipation, and an eight-pound weight gain. Before confirming a primary depressive
disorder, which action is most clinically sound?
A. Start a therapeutic SSRI dose immediately and reassess in one year
B. Order TSH, CBC, metabolic panel, and vitamin B12 to exclude medical mimics
C. Attribute the symptoms to normal aging and provide reassurance
D. Refer directly for electroconvulsive therapy given the somatic profile
Correct Answer: B
Rationale: New-onset depression in an older adult warrants laboratory evaluation because hypothyroidism, anemia,
and metabolic abnormalities can reproduce the syndrome. Treating a reversible medical cause first prevents years of
unnecessary psychiatric medication.
EXAM REVIEW & STUDY BANK · 2026/2027 Page 3
