NR 547 PSYCHIATRIC MENTAL HEALTH NURSING
(DIFFERENTIAL DIAGNOSIS ACROSS THE LIFESPAN)
2026 MIDTERM & FINAL EXAM PREP STUDY GUIDE.
SECTION 1: Differential Diagnosis Framework & Medical Rule-Outs
Question 1: According to the systematic differential diagnosis process, what is the
recommended FIRST step when evaluating a new psychiatric patient?
A) Determine the specific primary psychiatric disorder
B) Rule out substance/medication-induced etiologies
C) Rule out malingering or factitious disorder
D) Establish a hierarchy of comorbid conditions
Correct Answer: C
Rationale: The foundational first step in the differential diagnosis process is to
rule out malingering or factitious disorder. This is followed by ruling out
substance/medical causes, then other psychiatric etiologies, before determining
the specific primary disorder and establishing a treatment hierarchy.
Question 2: A 58-year-old female presents with persistent fatigue, low mood,
weight gain, and cold intolerance over the past 3 months. Before initiating
treatment for a depressive disorder, which laboratory test is the most critical to
rule out a medical etiology?
A) Comprehensive Metabolic Panel (CMP)
,B) Thyroid-Stimulating Hormone (TSH)
C) Vitamin B12 level
D) Urine drug screen
Correct Answer: B
Rationale: Hypothyroidism commonly presents with fatigue, low mood, weight
gain, and cold intolerance, closely mimicking major depressive disorder. A TSH
level is the most critical initial test to rule out this medical etiology before
diagnosing a primary psychiatric condition.
Question 3: A 79-year-old male is brought to the clinic due to a 2-day history of
acute confusion, fluctuating attention, and visual hallucinations. He has no prior
psychiatric history. A urinalysis is positive for leukocyte esterase and nitrites.
What is the most appropriate primary diagnosis to consider?
A) Major Neurocognitive Disorder due to Alzheimer’s disease
B) Delirium due to a medical condition (Urinary Tract Infection)
C) Late-onset Schizophrenia
D) Major Depressive Disorder with psychotic features
Correct Answer: B
Rationale: Delirium is characterized by an acute, fluctuating change in mental
status and attention, often triggered by a medical condition such as a UTI in older
adults. Alzheimer’s disease has an insidious, progressive onset over years, not
days.
SECTION 2: Mood Disorders (Depression & Bipolar)
,Question 4: A 28-year-old patient presents with passive thoughts that life is "not
worth living" but denies active suicidal ideation, plan, or intent. They report a 10-
day history of depressed mood, anhedonia, and insomnia. What is the most
appropriate initial action?
A) Immediately hospitalize the patient involuntarily
B) Provide a brief suicide safety assessment and schedule close follow-up
C) Prescribe an antidepressant and discharge with no follow-up
D) Reassure the patient that passive thoughts are not concerning
Correct Answer: B
Rationale: Passive suicidal thoughts warrant a formal but brief suicide safety
assessment to determine acuity and risk. They do not automatically require
involuntary hospitalization, but they do necessitate close monitoring and follow-
up, as the presence of a major depressive episode increases overall risk.
Question 5: A 35-year-old patient presents with a 2-year history of chronically
depressed mood, low energy, poor appetite, and low self-esteem. The patient
reports never being symptom-free for more than 2 months at a time. There is no
history of manic or hypomanic episodes. What is the most appropriate diagnosis?
A) Major Depressive Disorder, recurrent
B) Persistent Depressive Disorder (Dysthymia)
C) Cyclothymic Disorder
D) Adjustment Disorder with depressed mood
Correct Answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires a depressed mood
for most of the day, for more days than not, for at least 2 years in adults, without
, being symptom-free for more than 2 months. MDD is episodic, and Cyclothymia
requires hypomanic symptoms.
Question 6: A patient with a known history of major depressive episodes presents
with a 3-week history of grandiosity, decreased need for sleep, pressured speech,
and excessive involvement in high-risk activities (e.g., reckless spending). These
symptoms have caused marked occupational impairment. What is the most
accurate diagnosis?
A) Bipolar II Disorder, current hypomanic episode
B) Bipolar I Disorder, current manic episode
C) Cyclothymic Disorder
D) Major Depressive Disorder with mixed features
Correct Answer: B
Rationale: Bipolar I Disorder is defined by the occurrence of at least one full
manic episode, which lasts at least 1 week (or requires hospitalization) and causes
marked impairment in functioning. Bipolar II requires hypomania (no marked
impairment) and a history of major depression.
SECTION 3: Psychotic Disorders & Schizophrenia Spectrum
Question 7: Which of the following timeframes correctly distinguishes
Schizophreniform Disorder from Schizophrenia?
A) Schizophreniform lasts 1 day to 1 month; Schizophrenia lasts >1 month
B) Schizophreniform lasts 1 to 6 months; Schizophrenia lasts >6 months
C) Schizophreniform lasts >6 months; Schizophrenia is a lifelong diagnosis
D) There is no timeframe difference; the distinction is based on the presence of
(DIFFERENTIAL DIAGNOSIS ACROSS THE LIFESPAN)
2026 MIDTERM & FINAL EXAM PREP STUDY GUIDE.
SECTION 1: Differential Diagnosis Framework & Medical Rule-Outs
Question 1: According to the systematic differential diagnosis process, what is the
recommended FIRST step when evaluating a new psychiatric patient?
A) Determine the specific primary psychiatric disorder
B) Rule out substance/medication-induced etiologies
C) Rule out malingering or factitious disorder
D) Establish a hierarchy of comorbid conditions
Correct Answer: C
Rationale: The foundational first step in the differential diagnosis process is to
rule out malingering or factitious disorder. This is followed by ruling out
substance/medical causes, then other psychiatric etiologies, before determining
the specific primary disorder and establishing a treatment hierarchy.
Question 2: A 58-year-old female presents with persistent fatigue, low mood,
weight gain, and cold intolerance over the past 3 months. Before initiating
treatment for a depressive disorder, which laboratory test is the most critical to
rule out a medical etiology?
A) Comprehensive Metabolic Panel (CMP)
,B) Thyroid-Stimulating Hormone (TSH)
C) Vitamin B12 level
D) Urine drug screen
Correct Answer: B
Rationale: Hypothyroidism commonly presents with fatigue, low mood, weight
gain, and cold intolerance, closely mimicking major depressive disorder. A TSH
level is the most critical initial test to rule out this medical etiology before
diagnosing a primary psychiatric condition.
Question 3: A 79-year-old male is brought to the clinic due to a 2-day history of
acute confusion, fluctuating attention, and visual hallucinations. He has no prior
psychiatric history. A urinalysis is positive for leukocyte esterase and nitrites.
What is the most appropriate primary diagnosis to consider?
A) Major Neurocognitive Disorder due to Alzheimer’s disease
B) Delirium due to a medical condition (Urinary Tract Infection)
C) Late-onset Schizophrenia
D) Major Depressive Disorder with psychotic features
Correct Answer: B
Rationale: Delirium is characterized by an acute, fluctuating change in mental
status and attention, often triggered by a medical condition such as a UTI in older
adults. Alzheimer’s disease has an insidious, progressive onset over years, not
days.
SECTION 2: Mood Disorders (Depression & Bipolar)
,Question 4: A 28-year-old patient presents with passive thoughts that life is "not
worth living" but denies active suicidal ideation, plan, or intent. They report a 10-
day history of depressed mood, anhedonia, and insomnia. What is the most
appropriate initial action?
A) Immediately hospitalize the patient involuntarily
B) Provide a brief suicide safety assessment and schedule close follow-up
C) Prescribe an antidepressant and discharge with no follow-up
D) Reassure the patient that passive thoughts are not concerning
Correct Answer: B
Rationale: Passive suicidal thoughts warrant a formal but brief suicide safety
assessment to determine acuity and risk. They do not automatically require
involuntary hospitalization, but they do necessitate close monitoring and follow-
up, as the presence of a major depressive episode increases overall risk.
Question 5: A 35-year-old patient presents with a 2-year history of chronically
depressed mood, low energy, poor appetite, and low self-esteem. The patient
reports never being symptom-free for more than 2 months at a time. There is no
history of manic or hypomanic episodes. What is the most appropriate diagnosis?
A) Major Depressive Disorder, recurrent
B) Persistent Depressive Disorder (Dysthymia)
C) Cyclothymic Disorder
D) Adjustment Disorder with depressed mood
Correct Answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires a depressed mood
for most of the day, for more days than not, for at least 2 years in adults, without
, being symptom-free for more than 2 months. MDD is episodic, and Cyclothymia
requires hypomanic symptoms.
Question 6: A patient with a known history of major depressive episodes presents
with a 3-week history of grandiosity, decreased need for sleep, pressured speech,
and excessive involvement in high-risk activities (e.g., reckless spending). These
symptoms have caused marked occupational impairment. What is the most
accurate diagnosis?
A) Bipolar II Disorder, current hypomanic episode
B) Bipolar I Disorder, current manic episode
C) Cyclothymic Disorder
D) Major Depressive Disorder with mixed features
Correct Answer: B
Rationale: Bipolar I Disorder is defined by the occurrence of at least one full
manic episode, which lasts at least 1 week (or requires hospitalization) and causes
marked impairment in functioning. Bipolar II requires hypomania (no marked
impairment) and a history of major depression.
SECTION 3: Psychotic Disorders & Schizophrenia Spectrum
Question 7: Which of the following timeframes correctly distinguishes
Schizophreniform Disorder from Schizophrenia?
A) Schizophreniform lasts 1 day to 1 month; Schizophrenia lasts >1 month
B) Schizophreniform lasts 1 to 6 months; Schizophrenia lasts >6 months
C) Schizophreniform lasts >6 months; Schizophrenia is a lifelong diagnosis
D) There is no timeframe difference; the distinction is based on the presence of
