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NR547 WEEK 8 FINAL EXAM DUE 22ND
DECEMBER 2025 — DIFFERENTIAL
DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN —
QUESTIONS 1-100 AND ANSWERS
UPDATED 2026/2027 | DETAILED
RATIONALES | ADVANCED PRACTICE
INTRODUCTION
This comprehensive NR547 Week 8 Final Exam practice bank is designed for graduate-level
psychiatric-mental health nurse practitioner students preparing for advanced differential-
diagnosis assessment. NR547 focuses on applying systematic diagnostic reasoning to psychiatric
presentations across the lifespan, integrating history, mental-status findings, medical factors,
substance exposure, developmental considerations, and DSM-based diagnostic criteria.
Chamberlain identifies NR547 as the Differential Diagnosis in Psychiatric-Mental Health Across
the Lifespan Practicum within the PMHNP specialty track.
The questions below emphasize application rather than simple memorization. Each scenario
requires the learner to distinguish overlapping psychiatric conditions, identify medical or
substance-induced mimics, recognize developmental differences, interpret longitudinal symptom
patterns, and prioritize the most defensible differential diagnosis. The bank also incorporates risk
assessment, cognitive disorders, personality disorders, trauma-related disorders, psychotic
disorders, mood disorders, anxiety disorders, and substance-related conditions.
Use these questions to practice identifying the most discriminating clinical information,
eliminating competing diagnoses, and explaining the reasoning behind the final diagnostic
impression.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
1. Diagnostic Reasoning & DSM- Diagnostic formulation, duration,
Q1–12 12%
Based Assessment impairment, exclusion criteria
MDD, bipolar I/II, cyclothymia,
2. Mood Disorders Q13–25 13%
adjustment disorder
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Content Area Questions Key Topics Weight
3. Anxiety, Trauma & Obsessive-
Q26–37 GAD, panic, PTSD, OCD, acute stress 12%
Compulsive Disorders
Schizophrenia spectrum,
4. Psychotic Disorders Q38–49 12%
schizoaffective disorder, delusions
5. Substance-Related & Addictive Intoxication, withdrawal, SUD,
Q50–60 11%
Disorders substance-induced disorders
6. Neurocognitive & Delirium Delirium, dementia syndromes,
Q61–70 10%
Disorders differential diagnosis
Clusters A, B, C and longitudinal
7. Personality Disorders Q71–80 10%
patterns
8. Lifespan & Special-Population Children, adolescents, older adults,
Q81–90 10%
Diagnosis pregnancy, medical illness
Complex cases, comorbidity, diagnostic
9. Integrated Differential Diagnosis Q91–100 10%
prioritization
QUESTIONS 1–100
Q1:
A 32-year-old client reports six months of intermittent anxiety, depressed mood, insomnia, and
difficulty concentrating. Symptoms fluctuate considerably depending on work stress. During the
interview, the client reports no sustained period of elevated or expansive mood, decreased need
for sleep, grandiosity, or increased goal-directed activity. Which additional finding would be
MOST important before diagnosing major depressive disorder?
A) Whether the client has occasional irritability
B) Whether the symptoms meet the required duration, symptom-count, and functional-
impairment criteria for a major depressive episode
C) Whether the client has experienced workplace stress
D) Whether the client prefers psychotherapy over medication
Rationale: The correct answer is B because major depressive disorder requires a qualifying
major depressive episode with the appropriate symptom constellation, duration, clinically
significant distress or impairment, and exclusion of alternative explanations. A is insufficient
because irritability alone is nonspecific. C may contribute to symptoms but does not establish or
exclude MDD. D concerns treatment preference rather than diagnosis.
Q2:
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A 45-year-old patient presents with new-onset auditory hallucinations and paranoia. The
symptoms began two weeks after starting a medication known to produce psychotic adverse
effects. Which diagnostic principle should guide the clinician's next step?
A) Assume schizophrenia because hallucinations are present
B) Diagnose schizoaffective disorder immediately
C) Establish the temporal relationship between medication exposure and symptom onset
and evaluate for a substance/medication-induced psychotic disorder
D) Diagnose delusional disorder because the patient remains organized
Rationale: The correct answer is C because a new psychotic syndrome temporally associated
with medication exposure requires assessment for a medication-induced condition. A and B
prematurely assign primary psychotic disorders. D is inappropriate because hallucinations and
the broader presentation may exceed delusional disorder criteria.
Q3:
A client reports depressed mood every winter for several years, followed by complete remission
during spring and summer. The episodes have occurred during the same seasonal period for
multiple years and cause substantial occupational impairment. Which diagnostic feature is most
important?
A) Whether the client prefers colder weather
B) Whether the client has occasional insomnia in summer
C) Whether the depressive episodes demonstrate a consistent temporal relationship with a
particular season
D) Whether the client has previously used an antidepressant
Rationale: The correct answer is C because recurrent seasonal timing is central when
considering a seasonal pattern. A and B do not establish a clinically meaningful seasonal
pattern. D may influence treatment history but does not determine the diagnostic pattern.
Q4:
A 28-year-old patient reports three weeks of depressed mood, anhedonia, fatigue, impaired
concentration, and feelings of worthlessness following an unexpected divorce. Symptoms
substantially interfere with work. Which finding would most strongly support adjustment
disorder rather than major depressive disorder?
A) Sleep disturbance
B) Tearfulness
C) The symptoms do not meet full criteria for a major depressive episode and are closely
linked to the identifiable stressor
D) Reduced appetite
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Rationale: The correct answer is C because adjustment disorder requires an identifiable stressor
with a maladaptive response that does not better meet criteria for another disorder. A, B, and D
can occur in both adjustment disorder and major depressive episodes.
Q5:
A patient describes four days of markedly reduced sleep, increased energy, pressured speech, and
impulsive spending. The patient has never experienced psychosis and symptoms have not caused
hospitalization. Which additional finding would most strongly support hypomania?
A) Severe occupational impairment requiring hospitalization
B) Persistent hallucinations
C) A distinct period of elevated or irritable mood with increased activity that represents a
clear change from baseline without marked functional impairment
D) Depressed mood occurring simultaneously every day
Rationale: The correct answer is C because hypomania involves a distinct period of elevated,
expansive, or irritable mood with increased activity and observable change from baseline
without the severe impairment or psychosis characteristic of mania. A and B point toward mania
or another severe condition. D does not define hypomania.
Q6:
A 39-year-old patient has recurrent episodes of major depression and reports a previous period
lasting eight days during which he slept three hours nightly, became highly productive, spent
thousands of dollars, and was hospitalized after becoming severely disorganized. Which
diagnosis should be prioritized?
A) Bipolar II disorder
B) Bipolar I disorder
C) Persistent depressive disorder
D) Cyclothymic disorder
Rationale: The correct answer is B because a manic episode is sufficient for bipolar I disorder.
Bipolar II requires hypomania and major depression without a history of mania. C and D do not
account for a clear manic episode requiring hospitalization.
Q7:
A 67-year-old patient develops anxiety, insomnia, and visual hallucinations after several days of
severe medical illness. Symptoms fluctuate markedly throughout the day. Which feature most
strongly favors delirium over a primary psychotic disorder?
A) Presence of hallucinations
B) Older age alone
C) Acute onset with fluctuating attention and awareness associated with a medical
NR547 WEEK 8 FINAL EXAM DUE 22ND
DECEMBER 2025 — DIFFERENTIAL
DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN —
QUESTIONS 1-100 AND ANSWERS
UPDATED 2026/2027 | DETAILED
RATIONALES | ADVANCED PRACTICE
INTRODUCTION
This comprehensive NR547 Week 8 Final Exam practice bank is designed for graduate-level
psychiatric-mental health nurse practitioner students preparing for advanced differential-
diagnosis assessment. NR547 focuses on applying systematic diagnostic reasoning to psychiatric
presentations across the lifespan, integrating history, mental-status findings, medical factors,
substance exposure, developmental considerations, and DSM-based diagnostic criteria.
Chamberlain identifies NR547 as the Differential Diagnosis in Psychiatric-Mental Health Across
the Lifespan Practicum within the PMHNP specialty track.
The questions below emphasize application rather than simple memorization. Each scenario
requires the learner to distinguish overlapping psychiatric conditions, identify medical or
substance-induced mimics, recognize developmental differences, interpret longitudinal symptom
patterns, and prioritize the most defensible differential diagnosis. The bank also incorporates risk
assessment, cognitive disorders, personality disorders, trauma-related disorders, psychotic
disorders, mood disorders, anxiety disorders, and substance-related conditions.
Use these questions to practice identifying the most discriminating clinical information,
eliminating competing diagnoses, and explaining the reasoning behind the final diagnostic
impression.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
1. Diagnostic Reasoning & DSM- Diagnostic formulation, duration,
Q1–12 12%
Based Assessment impairment, exclusion criteria
MDD, bipolar I/II, cyclothymia,
2. Mood Disorders Q13–25 13%
adjustment disorder
,2|Page
Content Area Questions Key Topics Weight
3. Anxiety, Trauma & Obsessive-
Q26–37 GAD, panic, PTSD, OCD, acute stress 12%
Compulsive Disorders
Schizophrenia spectrum,
4. Psychotic Disorders Q38–49 12%
schizoaffective disorder, delusions
5. Substance-Related & Addictive Intoxication, withdrawal, SUD,
Q50–60 11%
Disorders substance-induced disorders
6. Neurocognitive & Delirium Delirium, dementia syndromes,
Q61–70 10%
Disorders differential diagnosis
Clusters A, B, C and longitudinal
7. Personality Disorders Q71–80 10%
patterns
8. Lifespan & Special-Population Children, adolescents, older adults,
Q81–90 10%
Diagnosis pregnancy, medical illness
Complex cases, comorbidity, diagnostic
9. Integrated Differential Diagnosis Q91–100 10%
prioritization
QUESTIONS 1–100
Q1:
A 32-year-old client reports six months of intermittent anxiety, depressed mood, insomnia, and
difficulty concentrating. Symptoms fluctuate considerably depending on work stress. During the
interview, the client reports no sustained period of elevated or expansive mood, decreased need
for sleep, grandiosity, or increased goal-directed activity. Which additional finding would be
MOST important before diagnosing major depressive disorder?
A) Whether the client has occasional irritability
B) Whether the symptoms meet the required duration, symptom-count, and functional-
impairment criteria for a major depressive episode
C) Whether the client has experienced workplace stress
D) Whether the client prefers psychotherapy over medication
Rationale: The correct answer is B because major depressive disorder requires a qualifying
major depressive episode with the appropriate symptom constellation, duration, clinically
significant distress or impairment, and exclusion of alternative explanations. A is insufficient
because irritability alone is nonspecific. C may contribute to symptoms but does not establish or
exclude MDD. D concerns treatment preference rather than diagnosis.
Q2:
,3|Page
A 45-year-old patient presents with new-onset auditory hallucinations and paranoia. The
symptoms began two weeks after starting a medication known to produce psychotic adverse
effects. Which diagnostic principle should guide the clinician's next step?
A) Assume schizophrenia because hallucinations are present
B) Diagnose schizoaffective disorder immediately
C) Establish the temporal relationship between medication exposure and symptom onset
and evaluate for a substance/medication-induced psychotic disorder
D) Diagnose delusional disorder because the patient remains organized
Rationale: The correct answer is C because a new psychotic syndrome temporally associated
with medication exposure requires assessment for a medication-induced condition. A and B
prematurely assign primary psychotic disorders. D is inappropriate because hallucinations and
the broader presentation may exceed delusional disorder criteria.
Q3:
A client reports depressed mood every winter for several years, followed by complete remission
during spring and summer. The episodes have occurred during the same seasonal period for
multiple years and cause substantial occupational impairment. Which diagnostic feature is most
important?
A) Whether the client prefers colder weather
B) Whether the client has occasional insomnia in summer
C) Whether the depressive episodes demonstrate a consistent temporal relationship with a
particular season
D) Whether the client has previously used an antidepressant
Rationale: The correct answer is C because recurrent seasonal timing is central when
considering a seasonal pattern. A and B do not establish a clinically meaningful seasonal
pattern. D may influence treatment history but does not determine the diagnostic pattern.
Q4:
A 28-year-old patient reports three weeks of depressed mood, anhedonia, fatigue, impaired
concentration, and feelings of worthlessness following an unexpected divorce. Symptoms
substantially interfere with work. Which finding would most strongly support adjustment
disorder rather than major depressive disorder?
A) Sleep disturbance
B) Tearfulness
C) The symptoms do not meet full criteria for a major depressive episode and are closely
linked to the identifiable stressor
D) Reduced appetite
, 4|Page
Rationale: The correct answer is C because adjustment disorder requires an identifiable stressor
with a maladaptive response that does not better meet criteria for another disorder. A, B, and D
can occur in both adjustment disorder and major depressive episodes.
Q5:
A patient describes four days of markedly reduced sleep, increased energy, pressured speech, and
impulsive spending. The patient has never experienced psychosis and symptoms have not caused
hospitalization. Which additional finding would most strongly support hypomania?
A) Severe occupational impairment requiring hospitalization
B) Persistent hallucinations
C) A distinct period of elevated or irritable mood with increased activity that represents a
clear change from baseline without marked functional impairment
D) Depressed mood occurring simultaneously every day
Rationale: The correct answer is C because hypomania involves a distinct period of elevated,
expansive, or irritable mood with increased activity and observable change from baseline
without the severe impairment or psychosis characteristic of mania. A and B point toward mania
or another severe condition. D does not define hypomania.
Q6:
A 39-year-old patient has recurrent episodes of major depression and reports a previous period
lasting eight days during which he slept three hours nightly, became highly productive, spent
thousands of dollars, and was hospitalized after becoming severely disorganized. Which
diagnosis should be prioritized?
A) Bipolar II disorder
B) Bipolar I disorder
C) Persistent depressive disorder
D) Cyclothymic disorder
Rationale: The correct answer is B because a manic episode is sufficient for bipolar I disorder.
Bipolar II requires hypomania and major depression without a history of mania. C and D do not
account for a clear manic episode requiring hospitalization.
Q7:
A 67-year-old patient develops anxiety, insomnia, and visual hallucinations after several days of
severe medical illness. Symptoms fluctuate markedly throughout the day. Which feature most
strongly favors delirium over a primary psychotic disorder?
A) Presence of hallucinations
B) Older age alone
C) Acute onset with fluctuating attention and awareness associated with a medical
