NR547 Midterm Exam – Differential Diagnosis
in Psychiatric-Mental Health Across the
Lifespan Practice Exam 2026/2027 | [Number]
Practice Questions & Study Guide | Complete
Exam-Style Questions with Correct Detailed
Answers & Rationales (Reliable Answers) |
Latest Updated Version | Instant Download
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Question 1
A 42-year-old patient presents with a 6-week history of new-
onset auditory hallucinations, paranoia, and social withdrawal.
Which action should the PMHNP prioritize when developing the
differential diagnosis?
A. Assume a primary psychotic disorder is present
B. Begin an antipsychotic before obtaining additional
information
C. Determine whether symptoms are caused by a personality
disorder
,D. Evaluate medical, neurologic, medication-related, and
substance-related causes
Answer: D
Rationale: New-onset psychotic symptoms require a broad
evaluation before assigning a primary psychiatric diagnosis.
Medical and neurologic illnesses, medications, intoxication, and
withdrawal can produce hallucinations, delusions, or behavioral
changes. A careful history, physical examination,
medication/substance review, and appropriate laboratory or
diagnostic testing help distinguish a primary psychiatric disorder
from a secondary cause.
Question 2
Which statement best describes the purpose of a differential
diagnosis?
A. It establishes the final diagnosis before treatment begins
B. It eliminates the need for laboratory testing
C. It provides a working list of plausible diagnoses that can be
narrowed using clinical evidence
D. It identifies only psychiatric disorders that meet DSM criteria
Answer: C
Rationale: A differential diagnosis is a structured working list of
possible explanations for a patient's presentation. The clinician
,progressively narrows the list by integrating symptoms,
duration, functional impairment, medical history, physical
findings, medications, substance exposure, laboratory findings,
and diagnostic criteria. This process improves diagnostic
accuracy and reduces premature diagnostic closure.
Question 3
A patient with newly developed depression reports fatigue,
constipation, cold intolerance, and difficulty concentrating.
Which laboratory evaluation is particularly important because a
medical disorder may be contributing to the presentation?
A. Serum amylase
B. Thyroid function testing
C. Serum troponin
D. Urine culture
Answer: B
Rationale: Hypothyroidism can produce symptoms that overlap
substantially with depression, including fatigue, cognitive
slowing, low mood, and reduced energy. Thyroid testing can
therefore help identify a potentially treatable medical
contributor to psychiatric symptoms. The presence of physical
symptoms such as cold intolerance and constipation increases
the importance of considering thyroid dysfunction.
, Question 4
A PMHNP is evaluating a patient with a first episode of
significant psychiatric symptoms. Which history is most
important for identifying potentially reversible contributors?
A. Favorite foods and recreational activities
B. Childhood academic performance only
C. Prescription medications, over-the-counter products,
supplements, alcohol, and recreational substances
D. Preferred method of psychotherapy
Answer: C
Rationale: A complete medication and substance history is
essential because prescription drugs, over-the-counter products,
supplements, alcohol, and recreational substances can cause or
worsen psychiatric symptoms. Some agents can produce
anxiety, insomnia, agitation, mood changes, psychosis, or
cognitive impairment. Identifying an exposure may substantially
change both the differential diagnosis and treatment plan.
Question 5
Which feature most strongly supports using a standardized
psychiatric rating scale during follow-up?
in Psychiatric-Mental Health Across the
Lifespan Practice Exam 2026/2027 | [Number]
Practice Questions & Study Guide | Complete
Exam-Style Questions with Correct Detailed
Answers & Rationales (Reliable Answers) |
Latest Updated Version | Instant Download
Question 1
A 42-year-old patient presents with a 6-week history of new-
onset auditory hallucinations, paranoia, and social withdrawal.
Which action should the PMHNP prioritize when developing the
differential diagnosis?
A. Assume a primary psychotic disorder is present
B. Begin an antipsychotic before obtaining additional
information
C. Determine whether symptoms are caused by a personality
disorder
,D. Evaluate medical, neurologic, medication-related, and
substance-related causes
Answer: D
Rationale: New-onset psychotic symptoms require a broad
evaluation before assigning a primary psychiatric diagnosis.
Medical and neurologic illnesses, medications, intoxication, and
withdrawal can produce hallucinations, delusions, or behavioral
changes. A careful history, physical examination,
medication/substance review, and appropriate laboratory or
diagnostic testing help distinguish a primary psychiatric disorder
from a secondary cause.
Question 2
Which statement best describes the purpose of a differential
diagnosis?
A. It establishes the final diagnosis before treatment begins
B. It eliminates the need for laboratory testing
C. It provides a working list of plausible diagnoses that can be
narrowed using clinical evidence
D. It identifies only psychiatric disorders that meet DSM criteria
Answer: C
Rationale: A differential diagnosis is a structured working list of
possible explanations for a patient's presentation. The clinician
,progressively narrows the list by integrating symptoms,
duration, functional impairment, medical history, physical
findings, medications, substance exposure, laboratory findings,
and diagnostic criteria. This process improves diagnostic
accuracy and reduces premature diagnostic closure.
Question 3
A patient with newly developed depression reports fatigue,
constipation, cold intolerance, and difficulty concentrating.
Which laboratory evaluation is particularly important because a
medical disorder may be contributing to the presentation?
A. Serum amylase
B. Thyroid function testing
C. Serum troponin
D. Urine culture
Answer: B
Rationale: Hypothyroidism can produce symptoms that overlap
substantially with depression, including fatigue, cognitive
slowing, low mood, and reduced energy. Thyroid testing can
therefore help identify a potentially treatable medical
contributor to psychiatric symptoms. The presence of physical
symptoms such as cold intolerance and constipation increases
the importance of considering thyroid dysfunction.
, Question 4
A PMHNP is evaluating a patient with a first episode of
significant psychiatric symptoms. Which history is most
important for identifying potentially reversible contributors?
A. Favorite foods and recreational activities
B. Childhood academic performance only
C. Prescription medications, over-the-counter products,
supplements, alcohol, and recreational substances
D. Preferred method of psychotherapy
Answer: C
Rationale: A complete medication and substance history is
essential because prescription drugs, over-the-counter products,
supplements, alcohol, and recreational substances can cause or
worsen psychiatric symptoms. Some agents can produce
anxiety, insomnia, agitation, mood changes, psychosis, or
cognitive impairment. Identifying an exposure may substantially
change both the differential diagnosis and treatment plan.
Question 5
Which feature most strongly supports using a standardized
psychiatric rating scale during follow-up?
