NR547 Week 9 Exam V2 | NR547
Differential Diagnosis in Psychiatric-
Mental Health across the Lifespan
Practicum | Q&A with Rationale (NR547
Week 9 Exam) | Chamberlain University
1. A 24-year-old female reports feeling ‘down’ for the past three weeks, loss of interest in
hobbies, and sleeping 10 hours a day. She denies any history of elevated mood or excessive
energy. What is the most likely primary diagnosis?
A. Persistent Depressive Disorder
B. Bipolar II Disorder
C. Major Depressive Disorder
D. Cyclothymic Disorder
Answer: C
Rationale: The patient meets the DSM-5-TR criteria for Major Depressive Disorder based
on the presence of five or more symptoms, including anhedonia and hypersomnia, for at
least two weeks. There is no evidence of hypomanic or manic episodes which would
suggest Bipolar Spectrum disorders. Persistent Depressive Disorder is ruled out because
the symptoms have not persisted for at least two years.
,2. When differentiating between Bipolar I and Bipolar II Disorder, which clinical feature is the
deciding factor?
A. The presence of at least one major depressive episode
B. The duration of depressive symptoms
C. The presence of rapid cycling
D. The occurrence of at least one manic episode
Answer: D
Rationale: Bipolar I Disorder requires the occurrence of at least one manic episode, which
involves a period of at least one week of abnormally elevated mood and increased energy.
Bipolar II Disorder requires at least one hypomanic episode and one major depressive
episode but specifically excludes full manic episodes. Manic episodes in Bipolar I may
include psychosis or require hospitalization, which is not required for a hypomanic
episode.
3. A 9-year-old child presents with chronic, severe irritability and frequent temper outbursts
that are out of proportion to the situation. These symptoms have been present for 14
months. What is the most appropriate diagnosis?
A. Oppositional Defiant Disorder
B. Bipolar I Disorder
C. Attention-Deficit/Hyperactivity Disorder
D. Disruptive Mood Dysregulation Disorder
,Answer: D
Rationale: Disruptive Mood Dysregulation Disorder (DMDD) was added to the DSM-5 to
address concerns about the overdiagnosis of Bipolar Disorder in children. The criteria
include severe recurrent temper outbursts and a persistently irritable or angry mood
between outbursts for at least 12 months. DMDD cannot be diagnosed before age 6 or after
age 18, and the symptoms must have started before age 10.
4. Which screening tool is most appropriate for assessing the severity of depressive
symptoms in an adult patient in a primary care setting?
A. GAD-7
B. MDQ
C. PHQ-9
D. CAGE-AID
Answer: C
Rationale: The Patient Health Questionnaire-9 (PHQ-9) is a validated, self-report
instrument used to screen for and monitor the severity of depression. It aligns with the
DSM-IV/DSM-5 criteria for Major Depressive Disorder. While GAD-7 measures anxiety and
the MDQ screens for Bipolar Disorder, the PHQ-9 is the gold standard for depression
severity assessment.
, 5. An elderly patient presents with memory loss, confusion, and depressed mood. The
symptoms began abruptly following the death of a spouse. What should the PMHNP consider
first in the differential?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Pseudodementia (Depression)
Answer: D
Rationale: Pseudodementia refers to the cognitive impairment that can accompany
depression in older adults, often characterized by a more rapid onset than true dementia.
Patients with pseudodementia frequently complain of memory loss, whereas those with
Alzheimer’s may try to hide it. Identifying this distinction is crucial as depression is
treatable and the cognitive symptoms may resolve with antidepressant therapy.
6. What is the minimum duration of symptoms required to diagnose a patient with
Generalized Anxiety Disorder (GAD)?
A. 2 weeks
B. 1 month
C. 3 months
D. 6 months
Differential Diagnosis in Psychiatric-
Mental Health across the Lifespan
Practicum | Q&A with Rationale (NR547
Week 9 Exam) | Chamberlain University
1. A 24-year-old female reports feeling ‘down’ for the past three weeks, loss of interest in
hobbies, and sleeping 10 hours a day. She denies any history of elevated mood or excessive
energy. What is the most likely primary diagnosis?
A. Persistent Depressive Disorder
B. Bipolar II Disorder
C. Major Depressive Disorder
D. Cyclothymic Disorder
Answer: C
Rationale: The patient meets the DSM-5-TR criteria for Major Depressive Disorder based
on the presence of five or more symptoms, including anhedonia and hypersomnia, for at
least two weeks. There is no evidence of hypomanic or manic episodes which would
suggest Bipolar Spectrum disorders. Persistent Depressive Disorder is ruled out because
the symptoms have not persisted for at least two years.
,2. When differentiating between Bipolar I and Bipolar II Disorder, which clinical feature is the
deciding factor?
A. The presence of at least one major depressive episode
B. The duration of depressive symptoms
C. The presence of rapid cycling
D. The occurrence of at least one manic episode
Answer: D
Rationale: Bipolar I Disorder requires the occurrence of at least one manic episode, which
involves a period of at least one week of abnormally elevated mood and increased energy.
Bipolar II Disorder requires at least one hypomanic episode and one major depressive
episode but specifically excludes full manic episodes. Manic episodes in Bipolar I may
include psychosis or require hospitalization, which is not required for a hypomanic
episode.
3. A 9-year-old child presents with chronic, severe irritability and frequent temper outbursts
that are out of proportion to the situation. These symptoms have been present for 14
months. What is the most appropriate diagnosis?
A. Oppositional Defiant Disorder
B. Bipolar I Disorder
C. Attention-Deficit/Hyperactivity Disorder
D. Disruptive Mood Dysregulation Disorder
,Answer: D
Rationale: Disruptive Mood Dysregulation Disorder (DMDD) was added to the DSM-5 to
address concerns about the overdiagnosis of Bipolar Disorder in children. The criteria
include severe recurrent temper outbursts and a persistently irritable or angry mood
between outbursts for at least 12 months. DMDD cannot be diagnosed before age 6 or after
age 18, and the symptoms must have started before age 10.
4. Which screening tool is most appropriate for assessing the severity of depressive
symptoms in an adult patient in a primary care setting?
A. GAD-7
B. MDQ
C. PHQ-9
D. CAGE-AID
Answer: C
Rationale: The Patient Health Questionnaire-9 (PHQ-9) is a validated, self-report
instrument used to screen for and monitor the severity of depression. It aligns with the
DSM-IV/DSM-5 criteria for Major Depressive Disorder. While GAD-7 measures anxiety and
the MDQ screens for Bipolar Disorder, the PHQ-9 is the gold standard for depression
severity assessment.
, 5. An elderly patient presents with memory loss, confusion, and depressed mood. The
symptoms began abruptly following the death of a spouse. What should the PMHNP consider
first in the differential?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Pseudodementia (Depression)
Answer: D
Rationale: Pseudodementia refers to the cognitive impairment that can accompany
depression in older adults, often characterized by a more rapid onset than true dementia.
Patients with pseudodementia frequently complain of memory loss, whereas those with
Alzheimer’s may try to hide it. Identifying this distinction is crucial as depression is
treatable and the cognitive symptoms may resolve with antidepressant therapy.
6. What is the minimum duration of symptoms required to diagnose a patient with
Generalized Anxiety Disorder (GAD)?
A. 2 weeks
B. 1 month
C. 3 months
D. 6 months
