NR547/ NR 547 FINAL EXAM (LATEST 2026/2027 UPDATE) |
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN PRACTICUM |
DEPRESSION, BIPOLAR DISORDER, DEMENTIA, SUD,
PERSONALITY DISORDERS COMPLETE EXAM QUESTIONS
AND ANSWERS | 2026–2027 LATEST UPDATE | DETAILED
RATIONALES | FULL STUDY GUIDE | EXAM PREP |
PRACTICE TEST | CERTIFICATION PREPARATION
1. A psychiatric-mental health nurse practitioner (PMHNP) is evaluating a 32-year-old
client who reports persistent sadness, low energy, poor concentration, and insomnia for the
past 3 weeks. Which additional finding would most strongly support a diagnosis of Major
Depressive Disorder (MDD)?
A. Elevated mood and decreased need for sleep
B. Recurrent panic attacks triggered by crowds
C. Loss of interest in previously enjoyable activities
D. Excessive worry occurring most days for 6 months
Correct Answer: C. Loss of interest in previously enjoyable activities
Rationale: Anhedonia is one of the hallmark symptoms of Major Depressive Disorder and is a
key diagnostic criterion. Elevated mood suggests mania, panic attacks suggest panic disorder,
and chronic excessive worry is more consistent with generalized anxiety disorder.
2. A 24-year-old client presents with episodes of elevated mood, increased goal-directed
activity, decreased need for sleep, and impulsive spending lasting 8 days. Which diagnosis
is most appropriate?
A. Bipolar I Disorder
B. Cyclothymic Disorder
C. Persistent Depressive Disorder
D. Generalized Anxiety Disorder
Correct Answer: A. Bipolar I Disorder
Rationale: A manic episode lasting at least 7 days or requiring hospitalization is diagnostic of
Bipolar I Disorder. Cyclothymia involves less severe symptoms, while the other conditions do
not involve mania.
3. During a cognitive assessment, an 80-year-old client demonstrates gradual memory
decline over several years and difficulty managing finances. Which diagnosis should be
considered first?
,A. Delirium
B. Major Neurocognitive Disorder due to Alzheimer's Disease
C. Schizophrenia
D. Acute Stress Disorder
Correct Answer: B. Major Neurocognitive Disorder due to Alzheimer's Disease
Rationale: Progressive memory loss and decline in executive functioning are characteristic of
Alzheimer's disease. Delirium presents acutely and fluctuates. Schizophrenia and acute stress
disorder do not primarily involve progressive cognitive decline.
4. A PMHNP suspects substance use disorder in a client. Which finding best indicates loss
of control over substance use?
A. Using substances only during social gatherings
B. Taking medication exactly as prescribed
C. Repeated unsuccessful attempts to cut down use
D. Experiencing mild cravings once monthly
Correct Answer: C. Repeated unsuccessful attempts to cut down use
Rationale: Repeated failed efforts to reduce or stop use are a key diagnostic feature of
substance use disorders. Social use alone and prescribed use do not indicate loss of control.
5. A client frequently displays unstable relationships, impulsivity, chronic feelings of
emptiness, and fear of abandonment. Which diagnosis is most likely?
A. Narcissistic Personality Disorder
B. Borderline Personality Disorder
C. Obsessive-Compulsive Personality Disorder
D. Avoidant Personality Disorder
Correct Answer: B. Borderline Personality Disorder
Rationale: Borderline Personality Disorder is characterized by instability in relationships, self-
image, affect regulation, and impulsive behaviors. Fear of abandonment is a hallmark
feature.
6. A 70-year-old hospitalized client becomes disoriented overnight and experiences
fluctuating levels of consciousness. What is the most likely diagnosis?
A. Alzheimer's Disease
B. Persistent Depressive Disorder
C. Delirium
D. Vascular Dementia
, Correct Answer: C. Delirium
Rationale: Delirium develops acutely and is characterized by fluctuating consciousness and
impaired attention. Dementia generally develops gradually and remains relatively stable day to
day.
7. Which symptom most clearly differentiates bipolar depression from unipolar
depression?
A. Depressed mood
B. Fatigue
C. Appetite changes
D. History of manic or hypomanic episodes
Correct Answer: D. History of manic or hypomanic episodes
Rationale: A history of mania or hypomania distinguishes bipolar disorders from major
depressive disorder. Depressive symptoms can occur in both conditions.
8. A PMHNP is assessing suicide risk. Which factor represents the highest level of
immediate concern?
A. Passive thoughts of death
B. History of depression
C. Detailed suicide plan with access to means
D. Recent job dissatisfaction
Correct Answer: C. Detailed suicide plan with access to means
Rationale: The presence of a specific plan and available means significantly increases
imminent suicide risk and requires urgent intervention.
9. A client reports hearing voices that comment on their actions despite no evidence of
substance use or mood episodes. Which diagnosis should be considered?
A. Schizophrenia
B. Bipolar II Disorder
C. Social Anxiety Disorder
D. Adjustment Disorder
Correct Answer: A. Schizophrenia
Rationale: Persistent auditory hallucinations and psychotic symptoms independent of mood
episodes strongly suggest schizophrenia.
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN PRACTICUM |
DEPRESSION, BIPOLAR DISORDER, DEMENTIA, SUD,
PERSONALITY DISORDERS COMPLETE EXAM QUESTIONS
AND ANSWERS | 2026–2027 LATEST UPDATE | DETAILED
RATIONALES | FULL STUDY GUIDE | EXAM PREP |
PRACTICE TEST | CERTIFICATION PREPARATION
1. A psychiatric-mental health nurse practitioner (PMHNP) is evaluating a 32-year-old
client who reports persistent sadness, low energy, poor concentration, and insomnia for the
past 3 weeks. Which additional finding would most strongly support a diagnosis of Major
Depressive Disorder (MDD)?
A. Elevated mood and decreased need for sleep
B. Recurrent panic attacks triggered by crowds
C. Loss of interest in previously enjoyable activities
D. Excessive worry occurring most days for 6 months
Correct Answer: C. Loss of interest in previously enjoyable activities
Rationale: Anhedonia is one of the hallmark symptoms of Major Depressive Disorder and is a
key diagnostic criterion. Elevated mood suggests mania, panic attacks suggest panic disorder,
and chronic excessive worry is more consistent with generalized anxiety disorder.
2. A 24-year-old client presents with episodes of elevated mood, increased goal-directed
activity, decreased need for sleep, and impulsive spending lasting 8 days. Which diagnosis
is most appropriate?
A. Bipolar I Disorder
B. Cyclothymic Disorder
C. Persistent Depressive Disorder
D. Generalized Anxiety Disorder
Correct Answer: A. Bipolar I Disorder
Rationale: A manic episode lasting at least 7 days or requiring hospitalization is diagnostic of
Bipolar I Disorder. Cyclothymia involves less severe symptoms, while the other conditions do
not involve mania.
3. During a cognitive assessment, an 80-year-old client demonstrates gradual memory
decline over several years and difficulty managing finances. Which diagnosis should be
considered first?
,A. Delirium
B. Major Neurocognitive Disorder due to Alzheimer's Disease
C. Schizophrenia
D. Acute Stress Disorder
Correct Answer: B. Major Neurocognitive Disorder due to Alzheimer's Disease
Rationale: Progressive memory loss and decline in executive functioning are characteristic of
Alzheimer's disease. Delirium presents acutely and fluctuates. Schizophrenia and acute stress
disorder do not primarily involve progressive cognitive decline.
4. A PMHNP suspects substance use disorder in a client. Which finding best indicates loss
of control over substance use?
A. Using substances only during social gatherings
B. Taking medication exactly as prescribed
C. Repeated unsuccessful attempts to cut down use
D. Experiencing mild cravings once monthly
Correct Answer: C. Repeated unsuccessful attempts to cut down use
Rationale: Repeated failed efforts to reduce or stop use are a key diagnostic feature of
substance use disorders. Social use alone and prescribed use do not indicate loss of control.
5. A client frequently displays unstable relationships, impulsivity, chronic feelings of
emptiness, and fear of abandonment. Which diagnosis is most likely?
A. Narcissistic Personality Disorder
B. Borderline Personality Disorder
C. Obsessive-Compulsive Personality Disorder
D. Avoidant Personality Disorder
Correct Answer: B. Borderline Personality Disorder
Rationale: Borderline Personality Disorder is characterized by instability in relationships, self-
image, affect regulation, and impulsive behaviors. Fear of abandonment is a hallmark
feature.
6. A 70-year-old hospitalized client becomes disoriented overnight and experiences
fluctuating levels of consciousness. What is the most likely diagnosis?
A. Alzheimer's Disease
B. Persistent Depressive Disorder
C. Delirium
D. Vascular Dementia
, Correct Answer: C. Delirium
Rationale: Delirium develops acutely and is characterized by fluctuating consciousness and
impaired attention. Dementia generally develops gradually and remains relatively stable day to
day.
7. Which symptom most clearly differentiates bipolar depression from unipolar
depression?
A. Depressed mood
B. Fatigue
C. Appetite changes
D. History of manic or hypomanic episodes
Correct Answer: D. History of manic or hypomanic episodes
Rationale: A history of mania or hypomania distinguishes bipolar disorders from major
depressive disorder. Depressive symptoms can occur in both conditions.
8. A PMHNP is assessing suicide risk. Which factor represents the highest level of
immediate concern?
A. Passive thoughts of death
B. History of depression
C. Detailed suicide plan with access to means
D. Recent job dissatisfaction
Correct Answer: C. Detailed suicide plan with access to means
Rationale: The presence of a specific plan and available means significantly increases
imminent suicide risk and requires urgent intervention.
9. A client reports hearing voices that comment on their actions despite no evidence of
substance use or mood episodes. Which diagnosis should be considered?
A. Schizophrenia
B. Bipolar II Disorder
C. Social Anxiety Disorder
D. Adjustment Disorder
Correct Answer: A. Schizophrenia
Rationale: Persistent auditory hallucinations and psychotic symptoms independent of mood
episodes strongly suggest schizophrenia.
