NRNP 6665 Final Exam Question and Answers 2026/2027 -
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Complex Differential Diagnosis Across Lifespan (Questions 1-30)
1. A 17-year-old male high school junior presents with 4 months of declining grades,
social withdrawal, and "strange" behavior per parents. He reports that he can "hear the
thoughts" of his classmates and believes the school cafeteria food is being poisoned
specifically to harm him. He showers only once weekly and has lost 15 pounds. His
maternal uncle was hospitalized for "nervous breakdown" in his 20s. Urine toxicology is
negative. On mental status exam, he has flat affect and poor eye contact. Which is the
most accurate diagnosis?
A. Cannabis Use Disorder with psychotic features
B. Schizophreniform Disorder
C. Schizophrenia
D. Schizotypal Personality Disorder
Correct Answer: C
Rationale: This patient meets DSM-5-TR criteria for Schizophrenia: presence of two or
more characteristic symptoms (delusions, hallucinations, disorganized
behavior/negative symptoms) for >6 months (4 months of active symptoms plus
prodromal decline), significant functional impairment (academic/social), and exclusion
,of substance use. The age of onset (late adolescence) and family history are typical.
Schizophreniform requires <6 months duration. Schizotypal PD would not show this
level of functional deterioration or frank psychotic symptoms. While cannabis can cause
psychosis, the negative toxicology and chronicity rule this out.
2. A 9-year-old female is referred by her school for "constant daydreaming" and failing to
complete assignments. Her teacher notes she stares blankly for 10-20 seconds several
times daily and is confused afterward. Her parents report she was previously an A
student but now seems "spacey." She sleeps 10 hours nightly and has no history of
trauma. Neurological exam is normal. Which diagnosis is most likely?
A. ADHD, Inattentive Presentation
B. Absence Seizure Disorder
C. Dissociative Disorder
D. Petit Mal Epilepsy with psychiatric comorbidity
Correct Answer: B
Rationale: The description of brief (10-20 second) staring spells with post-ictal
confusion (lethargy/confusion after) is classic for absence seizures, which often
present as academic decline in childhood. ADHD would not have the abrupt staring
episodes with confusion. Dissociative disorders in childhood are rare and typically
linked to trauma. While "Petit Mal" is an older term for absence seizures, option B is the
precise modern terminology. An EEG would confirm 3-Hz spike-and-wave pattern.
3. A 42-year-old woman presents with 6 months of fatigue, muscle aches, and difficulty
concentrating. She reports feeling "down" but attributes it to her chronic pain. She has
,seen multiple specialists who found no medical cause. Her PHQ-9 is 14, and she scores
high on the Somatic Symptom Scale-8. She denies suicidal ideation. Which diagnosis
best fits?
A. Major Depressive Disorder, Somatic Symptom Specifier
B. Somatic Symptom Disorder with depressive features
C. Fibromyalgia with secondary depression
D. Illness Anxiety Disorder
Correct Answer: B
Rationale: The patient has disproportionate and persistent thoughts about the
seriousness of her symptoms (implied by multiple specialist visits), high anxiety about
health, and excessive time/energy devoted to these symptoms for >6 months, meeting
SSD criteria. While she has depressive symptoms, they appear secondary to the
somatic focus. Illness Anxiety Disorder requires minimal somatic symptoms with high
anxiety about having a serious illness. Fibromyalgia is a medical diagnosis, not
psychiatric.
4. A 28-year-old graduate student presents after a breakup with 3 weeks of insomnia,
poor appetite with 8-pound weight loss, and difficulty concentrating. She reports feeling
"empty" and fears abandonment. She has a history of "stormy" relationships and has cut
herself superficially twice in the past year "to feel something." Her mood improves when
her best friend visits. Which diagnosis is primary?
A. Major Depressive Disorder, severe
B. Borderline Personality Disorder
, C. Adjustment Disorder with depressed mood
D. Bipolar II Disorder
Correct Answer: B
Rationale: The pattern of chronic interpersonal instability, fear of abandonment,
self-harm, and affective instability beginning in early adulthood is classic for BPD. The
mood reactivity (improvement with friend) and context (breakup triggering) differentiate
from MDD. While she meets some depressive criteria, the duration and pattern suggest
personality disorder. Adjustment disorder would not explain the chronic pattern of
"stormy relationships" and prior self-harm.
5. A 68-year-old retired accountant presents with 18 months of progressive memory
loss, getting lost driving familiar routes, and difficulty managing finances. His wife notes
he has become "apathetic" and no longer enjoys golf. MoCA score is 19/30 (points lost
on delayed recall, executive function). MRI shows mild cortical atrophy. Labs: TSH 2.5,
B12 450, folate 12. Which diagnosis is most accurate?
A. Major Neurocognitive Disorder due to Alzheimer's Disease
B. Mild Neurocognitive Disorder
C. Major Depressive Disorder with pseudodementia
D. Vascular Neurocognitive Disorder
Correct Answer: A
Rationale: The patient meets criteria for Major NCD: significant cognitive decline
interfering with independence in IADLs (finances, driving), documented deficits in
memory and executive function (MoCA 19), and insidious onset with gradual
WALDEN UNIVERSITY PMHNP Care Across the Lifespan |
Comprehensive Clinical Competency Assessment | Actual
Questions & Verified Answers | | Pass Guarantee
Complex Differential Diagnosis Across Lifespan (Questions 1-30)
1. A 17-year-old male high school junior presents with 4 months of declining grades,
social withdrawal, and "strange" behavior per parents. He reports that he can "hear the
thoughts" of his classmates and believes the school cafeteria food is being poisoned
specifically to harm him. He showers only once weekly and has lost 15 pounds. His
maternal uncle was hospitalized for "nervous breakdown" in his 20s. Urine toxicology is
negative. On mental status exam, he has flat affect and poor eye contact. Which is the
most accurate diagnosis?
A. Cannabis Use Disorder with psychotic features
B. Schizophreniform Disorder
C. Schizophrenia
D. Schizotypal Personality Disorder
Correct Answer: C
Rationale: This patient meets DSM-5-TR criteria for Schizophrenia: presence of two or
more characteristic symptoms (delusions, hallucinations, disorganized
behavior/negative symptoms) for >6 months (4 months of active symptoms plus
prodromal decline), significant functional impairment (academic/social), and exclusion
,of substance use. The age of onset (late adolescence) and family history are typical.
Schizophreniform requires <6 months duration. Schizotypal PD would not show this
level of functional deterioration or frank psychotic symptoms. While cannabis can cause
psychosis, the negative toxicology and chronicity rule this out.
2. A 9-year-old female is referred by her school for "constant daydreaming" and failing to
complete assignments. Her teacher notes she stares blankly for 10-20 seconds several
times daily and is confused afterward. Her parents report she was previously an A
student but now seems "spacey." She sleeps 10 hours nightly and has no history of
trauma. Neurological exam is normal. Which diagnosis is most likely?
A. ADHD, Inattentive Presentation
B. Absence Seizure Disorder
C. Dissociative Disorder
D. Petit Mal Epilepsy with psychiatric comorbidity
Correct Answer: B
Rationale: The description of brief (10-20 second) staring spells with post-ictal
confusion (lethargy/confusion after) is classic for absence seizures, which often
present as academic decline in childhood. ADHD would not have the abrupt staring
episodes with confusion. Dissociative disorders in childhood are rare and typically
linked to trauma. While "Petit Mal" is an older term for absence seizures, option B is the
precise modern terminology. An EEG would confirm 3-Hz spike-and-wave pattern.
3. A 42-year-old woman presents with 6 months of fatigue, muscle aches, and difficulty
concentrating. She reports feeling "down" but attributes it to her chronic pain. She has
,seen multiple specialists who found no medical cause. Her PHQ-9 is 14, and she scores
high on the Somatic Symptom Scale-8. She denies suicidal ideation. Which diagnosis
best fits?
A. Major Depressive Disorder, Somatic Symptom Specifier
B. Somatic Symptom Disorder with depressive features
C. Fibromyalgia with secondary depression
D. Illness Anxiety Disorder
Correct Answer: B
Rationale: The patient has disproportionate and persistent thoughts about the
seriousness of her symptoms (implied by multiple specialist visits), high anxiety about
health, and excessive time/energy devoted to these symptoms for >6 months, meeting
SSD criteria. While she has depressive symptoms, they appear secondary to the
somatic focus. Illness Anxiety Disorder requires minimal somatic symptoms with high
anxiety about having a serious illness. Fibromyalgia is a medical diagnosis, not
psychiatric.
4. A 28-year-old graduate student presents after a breakup with 3 weeks of insomnia,
poor appetite with 8-pound weight loss, and difficulty concentrating. She reports feeling
"empty" and fears abandonment. She has a history of "stormy" relationships and has cut
herself superficially twice in the past year "to feel something." Her mood improves when
her best friend visits. Which diagnosis is primary?
A. Major Depressive Disorder, severe
B. Borderline Personality Disorder
, C. Adjustment Disorder with depressed mood
D. Bipolar II Disorder
Correct Answer: B
Rationale: The pattern of chronic interpersonal instability, fear of abandonment,
self-harm, and affective instability beginning in early adulthood is classic for BPD. The
mood reactivity (improvement with friend) and context (breakup triggering) differentiate
from MDD. While she meets some depressive criteria, the duration and pattern suggest
personality disorder. Adjustment disorder would not explain the chronic pattern of
"stormy relationships" and prior self-harm.
5. A 68-year-old retired accountant presents with 18 months of progressive memory
loss, getting lost driving familiar routes, and difficulty managing finances. His wife notes
he has become "apathetic" and no longer enjoys golf. MoCA score is 19/30 (points lost
on delayed recall, executive function). MRI shows mild cortical atrophy. Labs: TSH 2.5,
B12 450, folate 12. Which diagnosis is most accurate?
A. Major Neurocognitive Disorder due to Alzheimer's Disease
B. Mild Neurocognitive Disorder
C. Major Depressive Disorder with pseudodementia
D. Vascular Neurocognitive Disorder
Correct Answer: A
Rationale: The patient meets criteria for Major NCD: significant cognitive decline
interfering with independence in IADLs (finances, driving), documented deficits in
memory and executive function (MoCA 19), and insidious onset with gradual
