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NR 547 Differential Diagnosis Midterm Exam 2026 –
Chamberlain University | 300 Practice Questions with
Detailed Rationales for PMHNP Students
Q1:
A 34-year-old female presents with a 3-week history of sudden-onset auditory
hallucinations commanding her to harm herself, disorganized speech, and bizarre
delusions. She has no prior psychiatric history and no mood symptoms. Her
symptoms began 2 days after a severe motor vehicle accident. What is the most
likely diagnosis?
A) Schizophrenia
B) Schizoaffective disorder
C) Brief psychotic disorder
D) PTSD with psychotic features
Answer: C) Brief psychotic disorder
Rationale: Brief psychotic disorder requires at least one psychotic symptom
lasting 1 day to <1 month, with return to baseline. The acute onset after a
stressor and absence of mood symptoms rule out schizophrenia (≥6 months)
and schizoaffective disorder.
Q2:
A 28-year-old male with schizophrenia on risperidone 4 mg daily for 6 months now
exhibits repetitive, involuntary grimacing and tongue protrusion. What is this side
effect?
A) Acute dystonia
B) Parkinsonism
C) Akathisia
D) Tardive dyskinesia
Answer: D) Tardive dyskinesia
Rationale: Tardive dyskinesia is a late-onset, irreversible movement disorder
from prolonged antipsychotic use, presenting with choreoathetoid movements
of the face/tongue.
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Q3:
A 45-year-old with treatment-resistant schizophrenia is started on clozapine. Which
lab test requires regular monitoring due to a life-threatening risk?
A) Serum glucose
B) CBC with differential
C) Liver function tests
D) Serum creatinine
Answer: B) CBC with differential
Rationale: Clozapine carries a 1–2% risk of agranulocytosis, requiring weekly
CBC monitoring initially, then biweekly, per REMS protocol.
Q4:
Which rating scale is most appropriate for monitoring depression severity with a
focus on somatic symptoms?
A) Beck Depression Inventory (BDI)
B) Hamilton Rating Scale for Depression (HAM-D)
C) PHQ-9
D) Montgomery-Åsberg Depression Rating Scale (MADRS)
Answer: B) Hamilton Rating Scale for Depression (HAM-D)
Rationale: The HAM-D emphasizes somatic symptoms (insomnia, appetite,
weight loss), while the BDI focuses more on cognitive/behavioral dimensions.
Q5:
A 22-year-old male has a 6-month history of auditory hallucinations, persecutory
delusions, disorganized speech, and social withdrawal with inability to work. What is
the most likely diagnosis?
A) Schizoaffective disorder
B) Schizophrenia
C) Brief psychotic disorder
D) Delusional disorder
Answer: B) Schizophrenia
Rationale: Schizophrenia requires ≥2 symptoms (delusions, hallucinations,
disorganized speech, negative symptoms) for ≥1 month and total duration ≥6
months with functional decline.
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Q6:
A patient scores 28 on the PANSS. This scale is primarily used to assess:
A) Depression severity
B) Anxiety symptoms
C) Schizophrenia symptom severity
D) PTSD symptoms
Answer: C) Schizophrenia symptom severity
Rationale: The PANSS (Positive and Negative Syndrome Scale) is the standard
tool for measuring symptom change in schizophrenia clinical trials.
Q7:
Which of the following is a negative symptom of schizophrenia?
A) Hallucinations
B) Delusions
C) Avolition
D) Disorganized speech
Answer: C) Avolition
Rationale: Negative symptoms include affective flattening, alogia, avolition,
anhedonia, and inattentiveness. Hallucinations, delusions, and disorganized
speech are positive symptoms.
Q8:
A patient on haloperidol develops acute torticollis and oculogyric crisis 2 hours after
the first dose. What is the best immediate treatment?
A) Benztropine IM
B) Diphenhydramine PO
C) Propranolol PO
D) Clonazepam PO
Answer: A) Benztropine IM
Rationale: Acute dystonia is an extrapyramidal symptom treated with
anticholinergics like benztropine or diphenhydramine, given IM for rapid effect.
,2|Page
NR 547 Differential Diagnosis Midterm Exam 2026 –
Chamberlain University | 300 Practice Questions with
Detailed Rationales for PMHNP Students
Q1:
A 34-year-old female presents with a 3-week history of sudden-onset auditory
hallucinations commanding her to harm herself, disorganized speech, and bizarre
delusions. She has no prior psychiatric history and no mood symptoms. Her
symptoms began 2 days after a severe motor vehicle accident. What is the most
likely diagnosis?
A) Schizophrenia
B) Schizoaffective disorder
C) Brief psychotic disorder
D) PTSD with psychotic features
Answer: C) Brief psychotic disorder
Rationale: Brief psychotic disorder requires at least one psychotic symptom
lasting 1 day to <1 month, with return to baseline. The acute onset after a
stressor and absence of mood symptoms rule out schizophrenia (≥6 months)
and schizoaffective disorder.
Q2:
A 28-year-old male with schizophrenia on risperidone 4 mg daily for 6 months now
exhibits repetitive, involuntary grimacing and tongue protrusion. What is this side
effect?
A) Acute dystonia
B) Parkinsonism
C) Akathisia
D) Tardive dyskinesia
Answer: D) Tardive dyskinesia
Rationale: Tardive dyskinesia is a late-onset, irreversible movement disorder
from prolonged antipsychotic use, presenting with choreoathetoid movements
of the face/tongue.
,3|Page
Q3:
A 45-year-old with treatment-resistant schizophrenia is started on clozapine. Which
lab test requires regular monitoring due to a life-threatening risk?
A) Serum glucose
B) CBC with differential
C) Liver function tests
D) Serum creatinine
Answer: B) CBC with differential
Rationale: Clozapine carries a 1–2% risk of agranulocytosis, requiring weekly
CBC monitoring initially, then biweekly, per REMS protocol.
Q4:
Which rating scale is most appropriate for monitoring depression severity with a
focus on somatic symptoms?
A) Beck Depression Inventory (BDI)
B) Hamilton Rating Scale for Depression (HAM-D)
C) PHQ-9
D) Montgomery-Åsberg Depression Rating Scale (MADRS)
Answer: B) Hamilton Rating Scale for Depression (HAM-D)
Rationale: The HAM-D emphasizes somatic symptoms (insomnia, appetite,
weight loss), while the BDI focuses more on cognitive/behavioral dimensions.
Q5:
A 22-year-old male has a 6-month history of auditory hallucinations, persecutory
delusions, disorganized speech, and social withdrawal with inability to work. What is
the most likely diagnosis?
A) Schizoaffective disorder
B) Schizophrenia
C) Brief psychotic disorder
D) Delusional disorder
Answer: B) Schizophrenia
Rationale: Schizophrenia requires ≥2 symptoms (delusions, hallucinations,
disorganized speech, negative symptoms) for ≥1 month and total duration ≥6
months with functional decline.
, 4|Page
Q6:
A patient scores 28 on the PANSS. This scale is primarily used to assess:
A) Depression severity
B) Anxiety symptoms
C) Schizophrenia symptom severity
D) PTSD symptoms
Answer: C) Schizophrenia symptom severity
Rationale: The PANSS (Positive and Negative Syndrome Scale) is the standard
tool for measuring symptom change in schizophrenia clinical trials.
Q7:
Which of the following is a negative symptom of schizophrenia?
A) Hallucinations
B) Delusions
C) Avolition
D) Disorganized speech
Answer: C) Avolition
Rationale: Negative symptoms include affective flattening, alogia, avolition,
anhedonia, and inattentiveness. Hallucinations, delusions, and disorganized
speech are positive symptoms.
Q8:
A patient on haloperidol develops acute torticollis and oculogyric crisis 2 hours after
the first dose. What is the best immediate treatment?
A) Benztropine IM
B) Diphenhydramine PO
C) Propranolol PO
D) Clonazepam PO
Answer: A) Benztropine IM
Rationale: Acute dystonia is an extrapyramidal symptom treated with
anticholinergics like benztropine or diphenhydramine, given IM for rapid effect.
