NR 547 Midterm Exam Differential Diagnosis
Psychiatric-Mental Health Across Lifespan
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
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SECTION 1: MOOD DISORDERS & DIFFERENTIAL DIAGNOSIS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old woman presents to the outpatient clinic reporting two weeks of persistent low mood,
anhedonia, early morning awakening, psychomotor retardation, and a 12-pound weight loss. She
denies any prior manic or hypomanic episodes. Her PHQ-9 score is 18. Her mother has a history of
bipolar I disorder. The PMHNP is considering whether to initiate an antidepressant or a mood
stabilizer. What is the most critical differential diagnosis consideration before selecting
pharmacotherapy?
A. Distinguishing major depressive disorder from persistent depressive disorder based on duration of
symptoms
B. Ruling out bipolar disorder by assessing for any history of elevated, expansive, or irritable mood
C. Differentiating major depressive disorder from adjustment disorder with depressed mood based on
stressor severity
D. Ruling out premenstrual dysphoric disorder by tracking symptoms across two menstrual cycles ✓
CORRECT
Correct Answer: B
Rationale: Before initiating antidepressant monotherapy in a patient with a first-episode major
depression and a first-degree relative with bipolar I disorder, the PMHNP must thoroughly assess for
any past hypomanic or manic symptoms, as antidepressant monotherapy can precipitate mania or
rapid cycling in undiagnosed bipolar disorder. Distinguishing persistent depressive disorder is less
urgent because both conditions respond to similar first-line antidepressant strategies, whereas
missing bipolarity carries serious pharmacologic risk. A careful family history and structured
screening for prior mood elevation are essential clinical safeguards in this scenario.
Question 2 of 50
,A 28-year-old man is brought to the emergency department by police after running through traffic
claiming he is "saving the world from alien invasion." He has not slept in four days, is hyperverbal with
pressured speech, and has spent $8,000 on electronic equipment in the past 72 hours. His girlfriend
reports he was "perfectly normal" two weeks ago and has no known psychiatric history. Urine drug
screen is negative. Vital signs are within normal limits. What is the most likely diagnosis?
A. Bipolar I disorder, current episode manic, with psychotic features
B. Schizoaffective disorder, bipolar type
C. Brief psychotic disorder
D. Substance/medication-induced bipolar and related disorder ✓ CORRECT
Correct Answer: A
Rationale: The patient meets DSM-5-TR criteria for a manic episode with marked impairment,
decreased need for sleep, grandiosity, excessive involvement in pleasurable activities with high
potential for painful consequences, and psychotic features (delusions), which in the absence of
substances or medical causes supports bipolar I disorder, current episode manic. Schizoaffective
disorder requires mood symptoms only during a minority of the total illness duration, which cannot
be established on a first presentation. Brief psychotic disorder lacks the prominent mood elevation,
decreased sleep, and expansive behavior seen here. The negative urine drug screen and absence of
substance use history make a substance-induced etiology unlikely.
Question 3 of 50
A 42-year-old woman with a known diagnosis of bipolar II disorder presents for a follow-up visit. She
reports that for the past three weeks she has felt "on top of the world," has been sleeping only three
hours per night without fatigue, has increased her work productivity dramatically, and has been more
talkative than usual. She denies any psychotic symptoms and states her functioning at work and
home has actually improved. Her significant other notes she seems "more energetic but not out of
control." What is the most accurate diagnostic clarification?
A. Major depressive disorder with atypical features
B. Bipolar II disorder, current episode hypomanic ✓ CORRECT
C. Cyclothymic disorder
D. Bipolar I disorder, current episode manic
Correct Answer: B
Rationale: The patient exhibits a distinct period of abnormally elevated mood, decreased need for
sleep, increased goal-directed activity, and pressured speech lasting three weeks, with no psychotic
features and no marked impairment in functioning, which meets DSM-5-TR criteria for a hypomanic
episode in the context of her established bipolar II disorder. Atypical depression features mood
reactivity and leaden paralysis, not elevated mood and decreased sleep. Cyclothymic disorder
requires numerous periods of hypomanic and depressive symptoms over at least two years without
, meeting full criteria for any mood episode. Bipolar I disorder requires a manic episode with marked
impairment or psychosis, neither of which is present.
Question 4 of 50
A 19-year-old college student presents to the university counseling center with two months of
depressed mood, loss of interest in activities, fatigue, poor concentration, and feelings of
worthlessness. She reports that these symptoms began shortly after failing a chemistry exam and
breaking up with her boyfriend. She continues to attend classes but her grades have dropped. She
denies suicidal ideation. She meets five of nine DSM-5-TR criteria for major depressive episode. What
is the most important factor that distinguishes her condition from adjustment disorder with
depressed mood?
A. The presence of a identifiable psychosocial stressor
B. The number and severity of depressive symptoms meeting full major depressive episode criteria ✓
CORRECT
C. The absence of suicidal ideation
D. The duration of symptoms being less than six months
Correct Answer: B
Rationale: While both adjustment disorder with depressed mood and major depressive disorder can
follow a stressor, the critical distinction is that adjustment disorder does not meet the full symptom
threshold, severity, or duration criteria for a major depressive episode; this patient meets five of nine
criteria with significant functional decline, supporting major depressive disorder. Both conditions can
have identifiable stressors, so that alone does not differentiate them. Suicidal ideation can occur in
either condition and is not a distinguishing feature. Duration is relevant but not definitive, as major
depression can remit within six months and adjustment disorder symptoms can persist if the stressor
continues.
Question 5 of 50
A 56-year-old man with a 20-year history of recurrent major depressive disorder presents with his
wife, who reports that for the past two years he has been increasingly irritable, pessimistic, and
withdrawn. The patient describes himself as having "always been depressed" and cannot recall a
two-month period in the past two years without depressive symptoms. He denies any periods of
elevated mood. His current PHQ-9 is 14. What is the most accurate diagnosis?
A. Major depressive disorder, recurrent, moderate
B. Persistent depressive disorder (dysthymia) ✓ CORRECT
C. Major depressive disorder, single episode, chronic specifier
D. Double depression
Psychiatric-Mental Health Across Lifespan
Official Practice Exam Actual Exam 2026/2027
with Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
═════════════════════════════════════
SECTION 1: MOOD DISORDERS & DIFFERENTIAL DIAGNOSIS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old woman presents to the outpatient clinic reporting two weeks of persistent low mood,
anhedonia, early morning awakening, psychomotor retardation, and a 12-pound weight loss. She
denies any prior manic or hypomanic episodes. Her PHQ-9 score is 18. Her mother has a history of
bipolar I disorder. The PMHNP is considering whether to initiate an antidepressant or a mood
stabilizer. What is the most critical differential diagnosis consideration before selecting
pharmacotherapy?
A. Distinguishing major depressive disorder from persistent depressive disorder based on duration of
symptoms
B. Ruling out bipolar disorder by assessing for any history of elevated, expansive, or irritable mood
C. Differentiating major depressive disorder from adjustment disorder with depressed mood based on
stressor severity
D. Ruling out premenstrual dysphoric disorder by tracking symptoms across two menstrual cycles ✓
CORRECT
Correct Answer: B
Rationale: Before initiating antidepressant monotherapy in a patient with a first-episode major
depression and a first-degree relative with bipolar I disorder, the PMHNP must thoroughly assess for
any past hypomanic or manic symptoms, as antidepressant monotherapy can precipitate mania or
rapid cycling in undiagnosed bipolar disorder. Distinguishing persistent depressive disorder is less
urgent because both conditions respond to similar first-line antidepressant strategies, whereas
missing bipolarity carries serious pharmacologic risk. A careful family history and structured
screening for prior mood elevation are essential clinical safeguards in this scenario.
Question 2 of 50
,A 28-year-old man is brought to the emergency department by police after running through traffic
claiming he is "saving the world from alien invasion." He has not slept in four days, is hyperverbal with
pressured speech, and has spent $8,000 on electronic equipment in the past 72 hours. His girlfriend
reports he was "perfectly normal" two weeks ago and has no known psychiatric history. Urine drug
screen is negative. Vital signs are within normal limits. What is the most likely diagnosis?
A. Bipolar I disorder, current episode manic, with psychotic features
B. Schizoaffective disorder, bipolar type
C. Brief psychotic disorder
D. Substance/medication-induced bipolar and related disorder ✓ CORRECT
Correct Answer: A
Rationale: The patient meets DSM-5-TR criteria for a manic episode with marked impairment,
decreased need for sleep, grandiosity, excessive involvement in pleasurable activities with high
potential for painful consequences, and psychotic features (delusions), which in the absence of
substances or medical causes supports bipolar I disorder, current episode manic. Schizoaffective
disorder requires mood symptoms only during a minority of the total illness duration, which cannot
be established on a first presentation. Brief psychotic disorder lacks the prominent mood elevation,
decreased sleep, and expansive behavior seen here. The negative urine drug screen and absence of
substance use history make a substance-induced etiology unlikely.
Question 3 of 50
A 42-year-old woman with a known diagnosis of bipolar II disorder presents for a follow-up visit. She
reports that for the past three weeks she has felt "on top of the world," has been sleeping only three
hours per night without fatigue, has increased her work productivity dramatically, and has been more
talkative than usual. She denies any psychotic symptoms and states her functioning at work and
home has actually improved. Her significant other notes she seems "more energetic but not out of
control." What is the most accurate diagnostic clarification?
A. Major depressive disorder with atypical features
B. Bipolar II disorder, current episode hypomanic ✓ CORRECT
C. Cyclothymic disorder
D. Bipolar I disorder, current episode manic
Correct Answer: B
Rationale: The patient exhibits a distinct period of abnormally elevated mood, decreased need for
sleep, increased goal-directed activity, and pressured speech lasting three weeks, with no psychotic
features and no marked impairment in functioning, which meets DSM-5-TR criteria for a hypomanic
episode in the context of her established bipolar II disorder. Atypical depression features mood
reactivity and leaden paralysis, not elevated mood and decreased sleep. Cyclothymic disorder
requires numerous periods of hypomanic and depressive symptoms over at least two years without
, meeting full criteria for any mood episode. Bipolar I disorder requires a manic episode with marked
impairment or psychosis, neither of which is present.
Question 4 of 50
A 19-year-old college student presents to the university counseling center with two months of
depressed mood, loss of interest in activities, fatigue, poor concentration, and feelings of
worthlessness. She reports that these symptoms began shortly after failing a chemistry exam and
breaking up with her boyfriend. She continues to attend classes but her grades have dropped. She
denies suicidal ideation. She meets five of nine DSM-5-TR criteria for major depressive episode. What
is the most important factor that distinguishes her condition from adjustment disorder with
depressed mood?
A. The presence of a identifiable psychosocial stressor
B. The number and severity of depressive symptoms meeting full major depressive episode criteria ✓
CORRECT
C. The absence of suicidal ideation
D. The duration of symptoms being less than six months
Correct Answer: B
Rationale: While both adjustment disorder with depressed mood and major depressive disorder can
follow a stressor, the critical distinction is that adjustment disorder does not meet the full symptom
threshold, severity, or duration criteria for a major depressive episode; this patient meets five of nine
criteria with significant functional decline, supporting major depressive disorder. Both conditions can
have identifiable stressors, so that alone does not differentiate them. Suicidal ideation can occur in
either condition and is not a distinguishing feature. Duration is relevant but not definitive, as major
depression can remit within six months and adjustment disorder symptoms can persist if the stressor
continues.
Question 5 of 50
A 56-year-old man with a 20-year history of recurrent major depressive disorder presents with his
wife, who reports that for the past two years he has been increasingly irritable, pessimistic, and
withdrawn. The patient describes himself as having "always been depressed" and cannot recall a
two-month period in the past two years without depressive symptoms. He denies any periods of
elevated mood. His current PHQ-9 is 14. What is the most accurate diagnosis?
A. Major depressive disorder, recurrent, moderate
B. Persistent depressive disorder (dysthymia) ✓ CORRECT
C. Major depressive disorder, single episode, chronic specifier
D. Double depression
