NR547 FINAL EXAM LATEST 2026/2027 |
Differential Diagnosis Psychiatric-Mental Health
Across Lifespan | Weeks 5-8 Practicum Exam
Newest Version 2026-2027 UP-TO-DATE EXAM
QUESTIONS AND 100% ACCURATE SOLUTIONS
| Question And VERIFIED ANSWERS - INSTANT
PDF DOWNLOAD.
Domain 1: Differential Diagnosis Process & Foundational
Concepts (Weeks 5-8 Review)
1. A PMHNP is conducting an initial psychiatric evaluation. Which of the following
best describes the primary purpose of the "differential diagnosis" process?
a) To confirm the patient's self-reported diagnosis
b) To develop a working list of potential disorders that could explain the patient's
symptoms
c) To rule out all medical causes of psychiatric symptoms before considering any mental
health diagnosis
d) To assign a single diagnosis that will guide all future treatment decisions
Correct Answer: b) To develop a working list of potential disorders that could explain
the patient's symptoms
Explanation: Differential diagnosis involves developing a working hypothesis or list of
potential disorders that could account for the presenting symptoms. This list is prioritized,
and each potential diagnosis is systematically ruled in or out based on diagnostic criteria,
history, and assessment findings .
,2. According to the DSM-5-TR, which of the following must be ruled out before
assigning most psychiatric diagnoses?
a) Childhood trauma history
b) Substance use and other medical conditions
c) Family history of mental illness
d) Recent stressful life events
Correct Answer: b) Substance use and other medical conditions
*Explanation: The DSM-5-TR requires clinicians to rule out substance/medication-
induced conditions and other medical conditions as the primary cause of symptoms
before assigning a primary psychiatric diagnosis .*
3. A 52-year-old client presents to the emergency department following a car
accident. The client describes persistent feelings of sadness and hopelessness and
states, "I sometimes think about what it would be like to take a handful of
sleeping pills and go to sleep forever." The client reports a previous suicide
attempt at age 16 but denies current suicidal intent. Based on the ASQ score, what
is the most appropriate response?
a) No action is necessary as the client is not currently considering suicide
b) Provide a brief suicide safety assessment
c) Alert the client's primary care physician only
d) Provide a STAT safety and full mental health evaluation
Correct Answer: b) Provide a brief suicide safety assessment
Explanation: While the client's responses do not indicate a need for a STAT full safety and
mental health evaluation (they deny current intent), the client requires a brief suicide
safety assessment to determine whether a full mental health evaluation is necessary. It is
also important to notify the clinician responsible for the client's care .
4. The SNAPPS method is a learning tool for clinical education. In this model, the
"P" stands for:
a) Prescribe medication
b) Plan the management of the client's health issues
c) Probe the patient's family history
d) Perform a physical exam
Correct Answer: b) Plan the management of the client's health issues
,*Explanation: The SNAPPS method includes: Summarize the history and findings, Narrow
the differential to 2-3 possibilities, Analyze the differential by comparing & contrasting,
Probe the preceptor by asking questions, Plan the management of the client's health
issues, and Select an issue for self-directed learning .*
5. Social determinants of health (SDOH) influence mental health outcomes. Which
is an example of an SDOH?
a) Genetic predisposition to depression
b) Discrimination, racism, and social exclusion
c) Medication side effects
d) Neurotransmitter imbalances
Correct Answer: b) Discrimination, racism, and social exclusion
Explanation: Social determinants of health are conditions in which people are born, grow,
live, work, and age. These include discrimination, racism, social exclusion, adverse
childhood experiences, poverty, housing instability, and lack of access to care .
Domain 2: Laboratory Interpretation & Medical Rule-Out
(Weeks 5-8)
6. A 58-year-old female presents with fatigue, depressed mood, and difficulty
concentrating. Her TSH is 6.3 mIU/L (normal 0.4-4.5). What is the most
appropriate next step?
a) Prescribe an SSRI for major depressive disorder
b) Refer to primary care for treatment of hypothyroidism before reassessing mood
symptoms
c) Diagnose adjustment disorder with depressed mood
d) Begin cognitive behavioral therapy for depression
Correct Answer: b) Refer to primary care for treatment of hypothyroidism before
reassessing mood symptoms
Explanation: An elevated TSH level (>4.0) indicates hypothyroidism, which is known to
cause depressive symptoms, fatigue, and cognitive impairment. The patient should be
referred for treatment of the underlying medical condition before a primary psychiatric
diagnosis is assigned .
, 7. A patient with no psychiatric history presents with acute confusion. Urinalysis is
positive for leukocyte esterase and nitrites. The PMHNP should:
a) Diagnose a primary psychotic disorder
b) Refer for treatment of urinary tract infection and monitor for resolution of confusion
c) Begin antipsychotic medication immediately
d) Admit to psychiatric unit for further evaluation
Correct Answer: b) Refer for treatment of urinary tract infection and monitor for
resolution of confusion
Explanation: Urinary tract infections (UTIs) are a common cause of acute mental status
changes, particularly in older adults. The positive urinalysis indicates infection, which
should be treated first before considering a primary psychiatric diagnosis .
8. A 19-year-old male presents with psychosis. His vitamin B12 level is 900
picograms/mL (normal 190-950). What is the most appropriate action?
a) Refer for B12 deficiency treatment
b) Begin treatment for psychosis
c) Repeat the B12 level in 1 month
d) Order a brain MRI
Correct Answer: b) Begin treatment for psychosis
*Explanation: The B12 level is within normal limits. Treatment for symptoms of psychosis
should be initiated. B12 deficiency below 190 pg/mL can cause mood disturbances,
mania, psychotic symptoms, and cognitive impairment, but this level is normal .*
9. A 64-year-old male presents with confusion. His serum creatinine is 7.0 mg/dL
(normal 0.6-1.2) and BUN is 32 mg/dL (normal 7-18). The PMHNP should:
a) Prescribe an antipsychotic for psychosis
b) Refer for evaluation of kidney function
c) Diagnose major neurocognitive disorder
d) Order a head CT
Correct Answer: b) Refer for evaluation of kidney function
Explanation: Elevated serum creatinine and BUN indicate a problem with kidney function,
which could contribute to confusion. The patient should be referred for medical evaluation
before a primary psychiatric diagnosis is assigned .
10. A 24-year-old female presents with anxiety. Her T3 is 260 ng/dL (normal 100-
200). What is the most appropriate next step?
Differential Diagnosis Psychiatric-Mental Health
Across Lifespan | Weeks 5-8 Practicum Exam
Newest Version 2026-2027 UP-TO-DATE EXAM
QUESTIONS AND 100% ACCURATE SOLUTIONS
| Question And VERIFIED ANSWERS - INSTANT
PDF DOWNLOAD.
Domain 1: Differential Diagnosis Process & Foundational
Concepts (Weeks 5-8 Review)
1. A PMHNP is conducting an initial psychiatric evaluation. Which of the following
best describes the primary purpose of the "differential diagnosis" process?
a) To confirm the patient's self-reported diagnosis
b) To develop a working list of potential disorders that could explain the patient's
symptoms
c) To rule out all medical causes of psychiatric symptoms before considering any mental
health diagnosis
d) To assign a single diagnosis that will guide all future treatment decisions
Correct Answer: b) To develop a working list of potential disorders that could explain
the patient's symptoms
Explanation: Differential diagnosis involves developing a working hypothesis or list of
potential disorders that could account for the presenting symptoms. This list is prioritized,
and each potential diagnosis is systematically ruled in or out based on diagnostic criteria,
history, and assessment findings .
,2. According to the DSM-5-TR, which of the following must be ruled out before
assigning most psychiatric diagnoses?
a) Childhood trauma history
b) Substance use and other medical conditions
c) Family history of mental illness
d) Recent stressful life events
Correct Answer: b) Substance use and other medical conditions
*Explanation: The DSM-5-TR requires clinicians to rule out substance/medication-
induced conditions and other medical conditions as the primary cause of symptoms
before assigning a primary psychiatric diagnosis .*
3. A 52-year-old client presents to the emergency department following a car
accident. The client describes persistent feelings of sadness and hopelessness and
states, "I sometimes think about what it would be like to take a handful of
sleeping pills and go to sleep forever." The client reports a previous suicide
attempt at age 16 but denies current suicidal intent. Based on the ASQ score, what
is the most appropriate response?
a) No action is necessary as the client is not currently considering suicide
b) Provide a brief suicide safety assessment
c) Alert the client's primary care physician only
d) Provide a STAT safety and full mental health evaluation
Correct Answer: b) Provide a brief suicide safety assessment
Explanation: While the client's responses do not indicate a need for a STAT full safety and
mental health evaluation (they deny current intent), the client requires a brief suicide
safety assessment to determine whether a full mental health evaluation is necessary. It is
also important to notify the clinician responsible for the client's care .
4. The SNAPPS method is a learning tool for clinical education. In this model, the
"P" stands for:
a) Prescribe medication
b) Plan the management of the client's health issues
c) Probe the patient's family history
d) Perform a physical exam
Correct Answer: b) Plan the management of the client's health issues
,*Explanation: The SNAPPS method includes: Summarize the history and findings, Narrow
the differential to 2-3 possibilities, Analyze the differential by comparing & contrasting,
Probe the preceptor by asking questions, Plan the management of the client's health
issues, and Select an issue for self-directed learning .*
5. Social determinants of health (SDOH) influence mental health outcomes. Which
is an example of an SDOH?
a) Genetic predisposition to depression
b) Discrimination, racism, and social exclusion
c) Medication side effects
d) Neurotransmitter imbalances
Correct Answer: b) Discrimination, racism, and social exclusion
Explanation: Social determinants of health are conditions in which people are born, grow,
live, work, and age. These include discrimination, racism, social exclusion, adverse
childhood experiences, poverty, housing instability, and lack of access to care .
Domain 2: Laboratory Interpretation & Medical Rule-Out
(Weeks 5-8)
6. A 58-year-old female presents with fatigue, depressed mood, and difficulty
concentrating. Her TSH is 6.3 mIU/L (normal 0.4-4.5). What is the most
appropriate next step?
a) Prescribe an SSRI for major depressive disorder
b) Refer to primary care for treatment of hypothyroidism before reassessing mood
symptoms
c) Diagnose adjustment disorder with depressed mood
d) Begin cognitive behavioral therapy for depression
Correct Answer: b) Refer to primary care for treatment of hypothyroidism before
reassessing mood symptoms
Explanation: An elevated TSH level (>4.0) indicates hypothyroidism, which is known to
cause depressive symptoms, fatigue, and cognitive impairment. The patient should be
referred for treatment of the underlying medical condition before a primary psychiatric
diagnosis is assigned .
, 7. A patient with no psychiatric history presents with acute confusion. Urinalysis is
positive for leukocyte esterase and nitrites. The PMHNP should:
a) Diagnose a primary psychotic disorder
b) Refer for treatment of urinary tract infection and monitor for resolution of confusion
c) Begin antipsychotic medication immediately
d) Admit to psychiatric unit for further evaluation
Correct Answer: b) Refer for treatment of urinary tract infection and monitor for
resolution of confusion
Explanation: Urinary tract infections (UTIs) are a common cause of acute mental status
changes, particularly in older adults. The positive urinalysis indicates infection, which
should be treated first before considering a primary psychiatric diagnosis .
8. A 19-year-old male presents with psychosis. His vitamin B12 level is 900
picograms/mL (normal 190-950). What is the most appropriate action?
a) Refer for B12 deficiency treatment
b) Begin treatment for psychosis
c) Repeat the B12 level in 1 month
d) Order a brain MRI
Correct Answer: b) Begin treatment for psychosis
*Explanation: The B12 level is within normal limits. Treatment for symptoms of psychosis
should be initiated. B12 deficiency below 190 pg/mL can cause mood disturbances,
mania, psychotic symptoms, and cognitive impairment, but this level is normal .*
9. A 64-year-old male presents with confusion. His serum creatinine is 7.0 mg/dL
(normal 0.6-1.2) and BUN is 32 mg/dL (normal 7-18). The PMHNP should:
a) Prescribe an antipsychotic for psychosis
b) Refer for evaluation of kidney function
c) Diagnose major neurocognitive disorder
d) Order a head CT
Correct Answer: b) Refer for evaluation of kidney function
Explanation: Elevated serum creatinine and BUN indicate a problem with kidney function,
which could contribute to confusion. The patient should be referred for medical evaluation
before a primary psychiatric diagnosis is assigned .
10. A 24-year-old female presents with anxiety. Her T3 is 260 ng/dL (normal 100-
200). What is the most appropriate next step?
