NR547 Differential Diagnosis in PMHNP Practicum
– Weeks 1-4 Midterm Exam Review (2026-2027) –
Complete Study Guide & Case Analysis | Psychiatric
Mental Health NP
50 items | DSM-5-TR based | Single-best-answer unless marked “SELECT ALL”
SECTION 1 – MOOD DISORDERS
Q1
A 28-year-old woman reports “I’ve been down and tired every day for the past 3 years.”
She can’t recall feeling “normal” since college. She denies suicidal thoughts, psychosis,
or periods of elevated mood. She continues to work but says “it’s a struggle.” BMI 24,
TSH 1.8 (nl). Which diagnosis is MOST likely?
A. Major Depressive Disorder, recurrent, moderate
B. Persistent Depressive Disorder (dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Adjustment Disorder with depressed mood
Answer: B
,Rationale: Depressed mood most days >2 years, no mania/hypomania, no full criteria
for major episode in past 2 years → meets PDD. MDD requires discrete episodes;
Adjustment is time-limited (<6 mo once stressor ends).
Q2
A 19-year-old college freshman presents 4 weeks after failing his first calculus exam.
He reports insomnia, low mood, “I can’t concentrate,” and missed two classes. He
denies anhedonia, appetite change, guilt, or suicidal ideation. He still plays video games
nightly with friends. The MOST accurate diagnosis is:
A. MDD, single episode, mild
B. Adjustment Disorder with mixed anxiety & depressed mood
C. Acute Stress Disorder
D. Normal adolescent stress reaction
Answer: B
Rationale: Clinically significant distress within 3 mo of identifiable stressor, symptoms
subthreshold for MDD/ASD, no dissociative cluster (rules out ASD).
Q3 (SELECT ALL)
Which features BEST distinguish a hypomanic episode from ADHD hyperactivity in a
15-year-old? (Select 3.)
A. Decreased need for sleep (feels rested after 3 h)
B. Onset before age 12
, C. Inflated self-esteem/grandiosity
D. Rapid speech present since elementary school
E. Marked increase in goal-directed activity beyond baseline
Answers: A, C, E
Rationale: A, C, E are specific to hypomania. B & D favor ADHD.
Q4
A 35-year-old man with known MDD on sertraline 100 mg reports 5 days of “I feel
incredible,” decreased sleep (3 h), hypersexuality, and spending $3,000 on crypto. He
started sertraline 6 weeks ago. Which is the NEXT BEST diagnostic step?
A. Increase sertraline to 150 mg
B. Obtain serum TSH & free T4
C. Discontinue sertraline immediately
D. Add lithium to treat breakthrough mania
Answer: B
Rationale: Rule out hyperthyroidism (medical mimic) before assuming
antidepressant-induced mania (which would indicate bipolar diathesis).
Q5
A 42-year-old woman with cyclothymic disorder asks how her illness differs from
Bipolar II. The PMHNP explains that cyclothymia:
– Weeks 1-4 Midterm Exam Review (2026-2027) –
Complete Study Guide & Case Analysis | Psychiatric
Mental Health NP
50 items | DSM-5-TR based | Single-best-answer unless marked “SELECT ALL”
SECTION 1 – MOOD DISORDERS
Q1
A 28-year-old woman reports “I’ve been down and tired every day for the past 3 years.”
She can’t recall feeling “normal” since college. She denies suicidal thoughts, psychosis,
or periods of elevated mood. She continues to work but says “it’s a struggle.” BMI 24,
TSH 1.8 (nl). Which diagnosis is MOST likely?
A. Major Depressive Disorder, recurrent, moderate
B. Persistent Depressive Disorder (dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Adjustment Disorder with depressed mood
Answer: B
,Rationale: Depressed mood most days >2 years, no mania/hypomania, no full criteria
for major episode in past 2 years → meets PDD. MDD requires discrete episodes;
Adjustment is time-limited (<6 mo once stressor ends).
Q2
A 19-year-old college freshman presents 4 weeks after failing his first calculus exam.
He reports insomnia, low mood, “I can’t concentrate,” and missed two classes. He
denies anhedonia, appetite change, guilt, or suicidal ideation. He still plays video games
nightly with friends. The MOST accurate diagnosis is:
A. MDD, single episode, mild
B. Adjustment Disorder with mixed anxiety & depressed mood
C. Acute Stress Disorder
D. Normal adolescent stress reaction
Answer: B
Rationale: Clinically significant distress within 3 mo of identifiable stressor, symptoms
subthreshold for MDD/ASD, no dissociative cluster (rules out ASD).
Q3 (SELECT ALL)
Which features BEST distinguish a hypomanic episode from ADHD hyperactivity in a
15-year-old? (Select 3.)
A. Decreased need for sleep (feels rested after 3 h)
B. Onset before age 12
, C. Inflated self-esteem/grandiosity
D. Rapid speech present since elementary school
E. Marked increase in goal-directed activity beyond baseline
Answers: A, C, E
Rationale: A, C, E are specific to hypomania. B & D favor ADHD.
Q4
A 35-year-old man with known MDD on sertraline 100 mg reports 5 days of “I feel
incredible,” decreased sleep (3 h), hypersexuality, and spending $3,000 on crypto. He
started sertraline 6 weeks ago. Which is the NEXT BEST diagnostic step?
A. Increase sertraline to 150 mg
B. Obtain serum TSH & free T4
C. Discontinue sertraline immediately
D. Add lithium to treat breakthrough mania
Answer: B
Rationale: Rule out hyperthyroidism (medical mimic) before assuming
antidepressant-induced mania (which would indicate bipolar diathesis).
Q5
A 42-year-old woman with cyclothymic disorder asks how her illness differs from
Bipolar II. The PMHNP explains that cyclothymia:
