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NR 547 CEA DIFFERENTIAL DIAGNOSIS PRACTICUM —
COMPREHENSIVE EXAM PREPARATION 2026/2027
COMPLETE (150) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
NR 547
Prepare effectively for the NR 547 CEA Differential Diagnosis Practicum at
Chamberlain with this focused study resource. It supports review of clinical
assessment, differential diagnosis, diagnostic reasoning, common presentations,
patient evaluation, and evidence-based decision-making. Use the material to
reinforce your clinical knowledge, review high-yield topics, and identify areas that may
require additional study. This resource is suited for Chamberlain nurse practitioner
students, advanced practice nursing learners, and candidates preparing for the NR
547 practicum assessment.
MULTIPLE CHOICE.
SECTION 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS & CLINICAL
REASONING (Questions 1–20)
1. What is the FIRST step in creating a differential diagnosis?
• A. Rule out substance etiology
• B. Rule out malingering or factitious disorder
• C. Rule out medical causes
• D. Rule out psychiatric causes
Answer: B. Rule out malingering or factitious disorder
Rationale: The first step in creating a differential diagnosis is to rule out
malingering or factitious disorder. This ensures that the patient's
presentation is not intentional (secondary gain) before proceeding with
the diagnostic process. The second step is to rule out substance etiology.
2. Which of the following best defines a differential diagnosis?
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• A. A final diagnosis based on laboratory results
• B. The provider's initial hypothesis—a working list of potential
problems associated with the chief complaint
• C. A treatment plan based on the patient's symptoms
• D. The patient's self-reported diagnosis
Answer: B. The provider's initial hypothesis—a working list of potential
problems associated with the chief complaint
Rationale: Differential diagnosis is defined as the provider's initial
hypothesis—a working list of potential problems that can be associated
with the initial or chief complaint. It is a dynamic process that evolves as
more information is gathered through history, examination, and
diagnostic testing.
3. A 45-year-old patient presents with new-onset anxiety, tremors, and
insomnia. Which of the following should be ruled out FIRST in the
differential diagnosis?
• A. Generalized anxiety disorder
• B. Substance-induced anxiety disorder
• C. Panic disorder
• D. Social anxiety disorder
Answer: B. Substance-induced anxiety disorder
Rationale: Substance-induced disorders should be ruled out early in the
diagnostic process because substance use (including alcohol, caffeine,
stimulants, and prescribed medications) can mimic or exacerbate
psychiatric symptoms. A thorough substance use history is essential
before attributing symptoms to a primary psychiatric disorder.
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4. A 16-year-old female presents with weight loss, amenorrhea, and
excessive exercise. The PMHNP suspects an eating disorder. Which is the
MOST important initial step in the differential diagnosis?
• A. Refer to a nutritionist
• B. Rule out medical causes of weight loss (e.g., thyroid disease,
gastrointestinal disorders)
• C. Start cognitive behavioral therapy
• D. Prescribe an SSRI
Answer: B. Rule out medical causes of weight loss (e.g., thyroid disease,
gastrointestinal disorders)
Rationale: Medical causes of weight loss must be ruled out before
attributing symptoms to a psychiatric disorder. Conditions such as
hyperthyroidism, inflammatory bowel disease, celiac disease, and
malignancies can present with weight loss and should be excluded
through appropriate history, physical examination, and laboratory testing.
5. A 28-year-old patient presents with auditory hallucinations and
paranoia. The PMHNP is considering a diagnosis of schizophrenia. Which
of the following should be ruled out FIRST?
• A. Bipolar disorder with psychotic features
• B. Substance-induced psychotic disorder
• C. Schizoaffective disorder
• D. Major depressive disorder with psychotic features
Answer: B. Substance-induced psychotic disorder
Rationale: Substance-induced psychotic disorder should be ruled out first
because substances such as amphetamines, cocaine, cannabis,
hallucinogens, and alcohol withdrawal can produce psychotic symptoms
that mimic primary psychotic disorders. A thorough substance use history
and toxicology screening are essential.
, Page 4 of 73
6. A 72-year-old patient presents with progressive memory loss, difficulty
with daily activities, and personality changes. Which of the following is
the MOST important initial step in the differential diagnosis?
• A. Start donepezil
• B. Rule out reversible causes of cognitive impairment (e.g., vitamin
B12 deficiency, hypothyroidism, infection)
• C. Refer to a neurologist
• D. Diagnose Alzheimer's disease
Answer: B. Rule out reversible causes of cognitive impairment (e.g.,
vitamin B12 deficiency, hypothyroidism, infection)
Rationale: Before diagnosing a neurodegenerative disorder such as
Alzheimer's disease, reversible causes of cognitive impairment must be
ruled out. These include vitamin B12 deficiency, hypothyroidism,
infections (UTI, syphilis), medication side effects, depression
(pseudodementia), and normal pressure hydrocephalus. A thorough
medical workup is essential.
7. What is the purpose of the mental status examination (MSE)?
• A. To diagnose specific psychiatric disorders
• B. To systematically assess the patient's cognitive, emotional, and
behavioral functioning
• C. To determine the patient's IQ
• D. To prescribe medications
Answer: B. To systematically assess the patient's cognitive, emotional,
and behavioral functioning
Rationale: The Mental Status Examination (MSE) is a structured
assessment of the patient's appearance, behavior, speech, mood, affect,
thought process, thought content, perception, cognition, insight, and
NR 547 CEA DIFFERENTIAL DIAGNOSIS PRACTICUM —
COMPREHENSIVE EXAM PREPARATION 2026/2027
COMPLETE (150) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
NR 547
Prepare effectively for the NR 547 CEA Differential Diagnosis Practicum at
Chamberlain with this focused study resource. It supports review of clinical
assessment, differential diagnosis, diagnostic reasoning, common presentations,
patient evaluation, and evidence-based decision-making. Use the material to
reinforce your clinical knowledge, review high-yield topics, and identify areas that may
require additional study. This resource is suited for Chamberlain nurse practitioner
students, advanced practice nursing learners, and candidates preparing for the NR
547 practicum assessment.
MULTIPLE CHOICE.
SECTION 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS & CLINICAL
REASONING (Questions 1–20)
1. What is the FIRST step in creating a differential diagnosis?
• A. Rule out substance etiology
• B. Rule out malingering or factitious disorder
• C. Rule out medical causes
• D. Rule out psychiatric causes
Answer: B. Rule out malingering or factitious disorder
Rationale: The first step in creating a differential diagnosis is to rule out
malingering or factitious disorder. This ensures that the patient's
presentation is not intentional (secondary gain) before proceeding with
the diagnostic process. The second step is to rule out substance etiology.
2. Which of the following best defines a differential diagnosis?
, Page 2 of 73
• A. A final diagnosis based on laboratory results
• B. The provider's initial hypothesis—a working list of potential
problems associated with the chief complaint
• C. A treatment plan based on the patient's symptoms
• D. The patient's self-reported diagnosis
Answer: B. The provider's initial hypothesis—a working list of potential
problems associated with the chief complaint
Rationale: Differential diagnosis is defined as the provider's initial
hypothesis—a working list of potential problems that can be associated
with the initial or chief complaint. It is a dynamic process that evolves as
more information is gathered through history, examination, and
diagnostic testing.
3. A 45-year-old patient presents with new-onset anxiety, tremors, and
insomnia. Which of the following should be ruled out FIRST in the
differential diagnosis?
• A. Generalized anxiety disorder
• B. Substance-induced anxiety disorder
• C. Panic disorder
• D. Social anxiety disorder
Answer: B. Substance-induced anxiety disorder
Rationale: Substance-induced disorders should be ruled out early in the
diagnostic process because substance use (including alcohol, caffeine,
stimulants, and prescribed medications) can mimic or exacerbate
psychiatric symptoms. A thorough substance use history is essential
before attributing symptoms to a primary psychiatric disorder.
, Page 3 of 73
4. A 16-year-old female presents with weight loss, amenorrhea, and
excessive exercise. The PMHNP suspects an eating disorder. Which is the
MOST important initial step in the differential diagnosis?
• A. Refer to a nutritionist
• B. Rule out medical causes of weight loss (e.g., thyroid disease,
gastrointestinal disorders)
• C. Start cognitive behavioral therapy
• D. Prescribe an SSRI
Answer: B. Rule out medical causes of weight loss (e.g., thyroid disease,
gastrointestinal disorders)
Rationale: Medical causes of weight loss must be ruled out before
attributing symptoms to a psychiatric disorder. Conditions such as
hyperthyroidism, inflammatory bowel disease, celiac disease, and
malignancies can present with weight loss and should be excluded
through appropriate history, physical examination, and laboratory testing.
5. A 28-year-old patient presents with auditory hallucinations and
paranoia. The PMHNP is considering a diagnosis of schizophrenia. Which
of the following should be ruled out FIRST?
• A. Bipolar disorder with psychotic features
• B. Substance-induced psychotic disorder
• C. Schizoaffective disorder
• D. Major depressive disorder with psychotic features
Answer: B. Substance-induced psychotic disorder
Rationale: Substance-induced psychotic disorder should be ruled out first
because substances such as amphetamines, cocaine, cannabis,
hallucinogens, and alcohol withdrawal can produce psychotic symptoms
that mimic primary psychotic disorders. A thorough substance use history
and toxicology screening are essential.
, Page 4 of 73
6. A 72-year-old patient presents with progressive memory loss, difficulty
with daily activities, and personality changes. Which of the following is
the MOST important initial step in the differential diagnosis?
• A. Start donepezil
• B. Rule out reversible causes of cognitive impairment (e.g., vitamin
B12 deficiency, hypothyroidism, infection)
• C. Refer to a neurologist
• D. Diagnose Alzheimer's disease
Answer: B. Rule out reversible causes of cognitive impairment (e.g.,
vitamin B12 deficiency, hypothyroidism, infection)
Rationale: Before diagnosing a neurodegenerative disorder such as
Alzheimer's disease, reversible causes of cognitive impairment must be
ruled out. These include vitamin B12 deficiency, hypothyroidism,
infections (UTI, syphilis), medication side effects, depression
(pseudodementia), and normal pressure hydrocephalus. A thorough
medical workup is essential.
7. What is the purpose of the mental status examination (MSE)?
• A. To diagnose specific psychiatric disorders
• B. To systematically assess the patient's cognitive, emotional, and
behavioral functioning
• C. To determine the patient's IQ
• D. To prescribe medications
Answer: B. To systematically assess the patient's cognitive, emotional,
and behavioral functioning
Rationale: The Mental Status Examination (MSE) is a structured
assessment of the patient's appearance, behavior, speech, mood, affect,
thought process, thought content, perception, cognition, insight, and
