NR547 /NR 547: Final Exam
Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum
2026| 2027| 2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 44-year-old man with alcohol use disorder presents 8 hours after his last drink with mild
tremors, anxiety, and insomnia. His vital signs are stable, and his CIWA-Ar score is 8. What is
the most appropriate clinical intervention?
A. Administer lorazepam 2 mg intravenously immediately
B. Provide supportive care with frequent reassessment
C. Transfer to the intensive care unit for delirium tremens monitoring
D. Initiate phenobarbital for seizure prophylaxis
Correct Answer: B
Rationale: Correct because a CIWA-Ar score of 8 falls within the mild withdrawal range below
10, indicating that supportive care with frequent reassessment is the appropriate intervention
rather than pharmacologic management. Benzodiazepines are reserved for moderate scores of
10-15 or severe scores above 15, and ICU transfer or phenobarbital is unnecessary for mild
withdrawal without autonomic instability or risk of delirium tremens. Close observation ensures
early detection of symptom progression while avoiding unnecessary sedation in a patient who
may recover with hydration and reassurance alone.
,Q2: A 38-year-old man lives alone, works a solitary night shift, and describes himself as "content
with my own company." He demonstrates restricted emotional expression, takes pleasure in
solitary technical hobbies, and shows indifference to both praise and criticism from his
supervisor. Which personality disorder best fits this presentation?
A. Avoidant Personality Disorder
B. Schizoid Personality Disorder
C. Dependent Personality Disorder
D. Paranoid Personality Disorder
Correct Answer: B
Rationale: Correct because Schizoid Personality Disorder is characterized by a pervasive pattern
of detachment from social relationships and a restricted range of emotional expression, including
genuine indifference to praise or criticism and contentment with solitary activities. Avoidant
Personality Disorder would present with intense fear of rejection and a desire for relationships
that is inhibited by anxiety, which contrasts with this patient's apparent comfort in isolation. The
flat affect and lack of desire for close bonds distinguish Schizoid Personality Disorder from other
Cluster A disorders that might present with social isolation due to paranoia or cognitive
distortion.
Q3: A 32-year-old man with heroin use disorder presents to a detoxification facility 16 hours
after his last use, complaining of severe muscle aches, anxiety, and insomnia. His vital signs
reveal mild tachycardia but stable blood pressure. Which medication is most appropriate for
managing his autonomic and anxiety symptoms?
A. Lorazepam for anxiety and sleep
B. Haloperidol for agitation control
C. Naltrexone to block cravings
D. Clonidine for autonomic hyperactivity and anxiety
Correct Answer: D
Rationale: Correct because clonidine, an alpha-2 adrenergic agonist, is the appropriate
pharmacologic intervention for managing autonomic symptoms and anxiety during opioid
withdrawal because it reduces norepinephrine release from the locus coeruleus without
producing opioid dependence. While lorazepam may reduce anxiety, it does not specifically
target the autonomic hyperactivity characteristic of opioid withdrawal and carries its own
dependence risk. Haloperidol is inappropriate as it fails to address the noradrenergic rebound
underlying withdrawal pathophysiology and may lower seizure threshold, whereas clonidine
directly mitigates rhinorrhea, piloerection, and tachycardia.
,Q4: A 77-year-old woman is referred for cognitive evaluation after her family notes she has lost
interest in activities, sleeps excessively, and frequently states "I don't know" when asked about
recent events. Her Geriatric Depression Scale score is 13/15. Which interpretation is most
appropriate?
A. Normal emotional adjustment to aging
B. Mild depression requiring only supportive counseling
C. Moderate depression with minimal cognitive impact
D. Severe depression likely causing pseudodementia
Correct Answer: D
Rationale: Correct because a Geriatric Depression Scale score of 13 falls within the severe range
of 12-15, indicating significant depressive symptomatology that frequently manifests as
pseudodementia in older adults. The GDS is specifically validated to distinguish late-life
depression from neurodegenerative disorders, and severe scores warrant immediate
antidepressant intervention and reevaluation of cognitive complaints. Attributing these symptoms
to primary dementia without addressing the underlying mood disorder would result in missed
opportunities for reversible cognitive improvement through depression treatment.
Q5: A 30-year-old man is brought for evaluation after staying awake for 5 days while working
on what he describes as a revolutionary business plan, during which he spent $12,000 on
equipment and insisted he would become famous within the month. His family notes he has been
talking rapidly and is easily distracted. Which mnemonic is most appropriate for tracking his
symptoms?
A. SIGECAPS for depressive episode criteria
B. COWS for withdrawal assessment
C. I WATCH DEATH for delirium etiologies
D. DIGFAST for manic episode criteria
Correct Answer: D
Rationale: Correct because the DIGFAST mnemonic is the standardized clinical tool used to
track and remember the cardinal symptoms of a manic episode in Bipolar Disorder, including
distractibility, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, and
talkativeness. SIGECAPS is used to identify major depressive episodes, COWS quantifies opioid
withdrawal severity, and I WATCH DEATH guides the workup for delirium etiologies, making
them incorrect for manic symptom assessment. Recognizing the appropriate mnemonic ensures
systematic evaluation of mood episodes and supports accurate differential diagnosis between
bipolar mania and other psychiatric conditions presenting with elevated mood or energy.
, Q6: A PMHNP is differentiating between delirium and dementia in an 84-year-old patient.
Which of the following findings on assessment support a diagnosis of delirium rather than
dementia? Select all that apply.
A. Insidious onset of memory impairment over 2 years
B. Fluctuating course with waxing and waning during the day
C. Altered level of consciousness with reduced environmental awareness
D. Progressive decline in executive function without fluctuation
Correct Answer(s): B, C
Rationale: Correct because delirium is fundamentally characterized by an acute fluctuating
course and altered level of consciousness with reduced awareness of the environment, which
distinguishes it from dementia per DSM-5-TR criteria. Insidious onset and progressive memory
decline over months to years are hallmark features of major neurocognitive disorder rather than
delirium, and clear sensorium throughout the day is inconsistent with the inattention and
awareness fluctuations required for delirium diagnosis. Accurate differentiation guides
immediate medical workup for reversible causes when delirium is suspected in vulnerable
populations.
Q7: A 58-year-old woman presents with 4 months of fatigue, weight gain, constipation,
depressed mood, and difficulty concentrating. Laboratory studies reveal TSH 8.5 mIU/L and free
T4 0.6 ng/dL. Which condition should be addressed before initiating antidepressant therapy?
A. Hypothyroidism
B. Hyperthyroidism
C. Addison's disease
D. Cushing's syndrome
Correct Answer: A
Rationale: Correct because an elevated TSH of 8.5 mIU/L with low free T4 confirms
hypothyroidism, which frequently mimics major depressive disorder through shared symptoms
of fatigue, weight changes, depressed mood, and cognitive slowing. Treating the underlying
endocrine disturbance with levothyroxine often resolves or significantly improves mood
symptoms without requiring antidepressant pharmacotherapy. Initiating sertraline or lithium
without addressing the physiological cause would be premature, and brain MRI is unnecessary
without neurological signs suggesting pituitary pathology.
Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum
2026| 2027| 2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 44-year-old man with alcohol use disorder presents 8 hours after his last drink with mild
tremors, anxiety, and insomnia. His vital signs are stable, and his CIWA-Ar score is 8. What is
the most appropriate clinical intervention?
A. Administer lorazepam 2 mg intravenously immediately
B. Provide supportive care with frequent reassessment
C. Transfer to the intensive care unit for delirium tremens monitoring
D. Initiate phenobarbital for seizure prophylaxis
Correct Answer: B
Rationale: Correct because a CIWA-Ar score of 8 falls within the mild withdrawal range below
10, indicating that supportive care with frequent reassessment is the appropriate intervention
rather than pharmacologic management. Benzodiazepines are reserved for moderate scores of
10-15 or severe scores above 15, and ICU transfer or phenobarbital is unnecessary for mild
withdrawal without autonomic instability or risk of delirium tremens. Close observation ensures
early detection of symptom progression while avoiding unnecessary sedation in a patient who
may recover with hydration and reassurance alone.
,Q2: A 38-year-old man lives alone, works a solitary night shift, and describes himself as "content
with my own company." He demonstrates restricted emotional expression, takes pleasure in
solitary technical hobbies, and shows indifference to both praise and criticism from his
supervisor. Which personality disorder best fits this presentation?
A. Avoidant Personality Disorder
B. Schizoid Personality Disorder
C. Dependent Personality Disorder
D. Paranoid Personality Disorder
Correct Answer: B
Rationale: Correct because Schizoid Personality Disorder is characterized by a pervasive pattern
of detachment from social relationships and a restricted range of emotional expression, including
genuine indifference to praise or criticism and contentment with solitary activities. Avoidant
Personality Disorder would present with intense fear of rejection and a desire for relationships
that is inhibited by anxiety, which contrasts with this patient's apparent comfort in isolation. The
flat affect and lack of desire for close bonds distinguish Schizoid Personality Disorder from other
Cluster A disorders that might present with social isolation due to paranoia or cognitive
distortion.
Q3: A 32-year-old man with heroin use disorder presents to a detoxification facility 16 hours
after his last use, complaining of severe muscle aches, anxiety, and insomnia. His vital signs
reveal mild tachycardia but stable blood pressure. Which medication is most appropriate for
managing his autonomic and anxiety symptoms?
A. Lorazepam for anxiety and sleep
B. Haloperidol for agitation control
C. Naltrexone to block cravings
D. Clonidine for autonomic hyperactivity and anxiety
Correct Answer: D
Rationale: Correct because clonidine, an alpha-2 adrenergic agonist, is the appropriate
pharmacologic intervention for managing autonomic symptoms and anxiety during opioid
withdrawal because it reduces norepinephrine release from the locus coeruleus without
producing opioid dependence. While lorazepam may reduce anxiety, it does not specifically
target the autonomic hyperactivity characteristic of opioid withdrawal and carries its own
dependence risk. Haloperidol is inappropriate as it fails to address the noradrenergic rebound
underlying withdrawal pathophysiology and may lower seizure threshold, whereas clonidine
directly mitigates rhinorrhea, piloerection, and tachycardia.
,Q4: A 77-year-old woman is referred for cognitive evaluation after her family notes she has lost
interest in activities, sleeps excessively, and frequently states "I don't know" when asked about
recent events. Her Geriatric Depression Scale score is 13/15. Which interpretation is most
appropriate?
A. Normal emotional adjustment to aging
B. Mild depression requiring only supportive counseling
C. Moderate depression with minimal cognitive impact
D. Severe depression likely causing pseudodementia
Correct Answer: D
Rationale: Correct because a Geriatric Depression Scale score of 13 falls within the severe range
of 12-15, indicating significant depressive symptomatology that frequently manifests as
pseudodementia in older adults. The GDS is specifically validated to distinguish late-life
depression from neurodegenerative disorders, and severe scores warrant immediate
antidepressant intervention and reevaluation of cognitive complaints. Attributing these symptoms
to primary dementia without addressing the underlying mood disorder would result in missed
opportunities for reversible cognitive improvement through depression treatment.
Q5: A 30-year-old man is brought for evaluation after staying awake for 5 days while working
on what he describes as a revolutionary business plan, during which he spent $12,000 on
equipment and insisted he would become famous within the month. His family notes he has been
talking rapidly and is easily distracted. Which mnemonic is most appropriate for tracking his
symptoms?
A. SIGECAPS for depressive episode criteria
B. COWS for withdrawal assessment
C. I WATCH DEATH for delirium etiologies
D. DIGFAST for manic episode criteria
Correct Answer: D
Rationale: Correct because the DIGFAST mnemonic is the standardized clinical tool used to
track and remember the cardinal symptoms of a manic episode in Bipolar Disorder, including
distractibility, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, and
talkativeness. SIGECAPS is used to identify major depressive episodes, COWS quantifies opioid
withdrawal severity, and I WATCH DEATH guides the workup for delirium etiologies, making
them incorrect for manic symptom assessment. Recognizing the appropriate mnemonic ensures
systematic evaluation of mood episodes and supports accurate differential diagnosis between
bipolar mania and other psychiatric conditions presenting with elevated mood or energy.
, Q6: A PMHNP is differentiating between delirium and dementia in an 84-year-old patient.
Which of the following findings on assessment support a diagnosis of delirium rather than
dementia? Select all that apply.
A. Insidious onset of memory impairment over 2 years
B. Fluctuating course with waxing and waning during the day
C. Altered level of consciousness with reduced environmental awareness
D. Progressive decline in executive function without fluctuation
Correct Answer(s): B, C
Rationale: Correct because delirium is fundamentally characterized by an acute fluctuating
course and altered level of consciousness with reduced awareness of the environment, which
distinguishes it from dementia per DSM-5-TR criteria. Insidious onset and progressive memory
decline over months to years are hallmark features of major neurocognitive disorder rather than
delirium, and clear sensorium throughout the day is inconsistent with the inattention and
awareness fluctuations required for delirium diagnosis. Accurate differentiation guides
immediate medical workup for reversible causes when delirium is suspected in vulnerable
populations.
Q7: A 58-year-old woman presents with 4 months of fatigue, weight gain, constipation,
depressed mood, and difficulty concentrating. Laboratory studies reveal TSH 8.5 mIU/L and free
T4 0.6 ng/dL. Which condition should be addressed before initiating antidepressant therapy?
A. Hypothyroidism
B. Hyperthyroidism
C. Addison's disease
D. Cushing's syndrome
Correct Answer: A
Rationale: Correct because an elevated TSH of 8.5 mIU/L with low free T4 confirms
hypothyroidism, which frequently mimics major depressive disorder through shared symptoms
of fatigue, weight changes, depressed mood, and cognitive slowing. Treating the underlying
endocrine disturbance with levothyroxine often resolves or significantly improves mood
symptoms without requiring antidepressant pharmacotherapy. Initiating sertraline or lithium
without addressing the physiological cause would be premature, and brain MRI is unnecessary
without neurological signs suggesting pituitary pathology.
