NR 547 FINAL EXAM 2026 | MENTAL HEALTH NURSING
QUESTIONS & DETAILED RATIONALES
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH
ACROSS THE LIFESPAN PRACTICUM | CHAMBERLAIN
UNIVERSITY
SECTION 1: MOOD DISORDERS
Question 1
A 28-year-old graduate student presents with a 3-week history of pervasive low mood,
anhedonia, 10-lb weight loss, and insomnia with early morning awakening. She endorses
passive suicidal ideation but has no plan. She reports a similar but milder episode at age 19.
During the interview, you note her speech is pressured, she is distractible, and she reveals she
has been working on multiple creative projects simultaneously for the past 5 days, feeling "like
my brain is on fire and I don't need sleep."
What is the most accurate initial diagnosis?
A. Major Depressive Disorder, single episode, severe
B. Bipolar I Disorder, current episode depressed
C. Bipolar II Disorder, current episode depressed
D. Cyclothymic Disorder
Correct Answer: C
,Rationale: The patient meets criteria for a current Major Depressive Episode (depressed mood,
anhedonia, weight loss, insomnia, suicidal ideation). The critical diagnostic feature is the
reported 5-day period of hypomanic symptoms (decreased need for sleep, increased goal-
directed activity, distractibility, racing thoughts). A full manic episode (Bipolar I) would require
at least 7 days of symptoms causing marked impairment or requiring hospitalization; this
vignette describes hypomania (≥4 days, no marked impairment). Therefore, the history of a
major depressive episode and at least one hypomanic episode establishes Bipolar II Disorder.
Cyclothymia involves hypomanic and depressive symptoms that do not meet full episode
criteria .
Key Distinction: Bipolar II requires at least one major depressive episode and one hypomanic
episode. Bipolar I requires a full manic episode (which may have psychotic features or require
hospitalization).
Question 2
A 45-year-old veteran presents with his wife. She reports he is emotionally distant, irritable,
and has severe insomnia with nightmares. He startles excessively, avoids crowded places, and
has not visited friends since returning from deployment 10 months ago. He denies depressed
mood but admits to constant hypervigilance and feeling "numb inside." He meets full criteria
for PTSD. On mental status exam, you note a blunt affect, but he is fully oriented. His wife
mentions he has begun to repeatedly check that the stove is off before leaving the house, a
ritual that takes 30 minutes and causes arguments.
What is the most appropriate additional diagnosis to consider?
A. Illness Anxiety Disorder
B. Obsessive-Compulsive Disorder
C. Generalized Anxiety Disorder
D. Adjustment Disorder with Anxiety
,Correct Answer: B
Rationale: While OCD and PTSD are both trauma- and stressor-related disorders in DSM-5-TR,
they can be comorbid. The presence of true obsessions (recurrent, intrusive thoughts about the
stove being on leading to anxiety) and compulsions (the repetitive checking behavior
performed to neutralize the anxiety) that are time-consuming (30 minutes) and cause distress
meets criteria for OCD. The symptoms are not solely focused on the traumatic event,
differentiating them from PTSD symptoms (which would involve trauma-related triggers). GAD
would involve excessive worry about multiple events, not ritualistic behaviors .
Clinical Pearl: Always assess for comorbid OCD in PTSD patients; the obsessions in OCD are ego-
dystonic and not trauma-specific.
SECTION 2: NEUROCOGNITIVE DISORDERS
Question 3
A 72-year-old man with hypertension and type 2 diabetes is brought in by his daughter for
"confusion." Over the past 18 months, he has had a progressive decline in his ability to manage
finances and medications. He recently got lost driving to the grocery store. His MMSE score is
22/30, with deficits in orientation, recall, and visuospatial tasks (cannot copy intersecting
pentagons). His neurological exam is notable for mild asymmetric rigidity and a shuffling gait.
He has no tremor.
Which neurocognitive disorder is most likely?
A. Alzheimer's Disease
B. Vascular Neurocognitive Disorder
C. Neurocognitive Disorder with Lewy Bodies
D. Frontotemporal Neurocognitive Disorder
Correct Answer: C
, Rationale: The key features are progressive cognitive decline plus core features of Lewy Body
Dementia: spontaneous parkinsonism (rigidity, gait disturbance) and prominent visuospatial
deficits. The absence of tremor and the presence of early visuospatial and attentional deficits
help differentiate it from Parkinson's Disease Dementia (which would have motor symptoms
preceding cognitive decline by a year or more). Alzheimer's typically presents with early
memory impairment; vascular NCD would show a stepwise decline and focal neurological signs;
FTD presents with early personality/behavior or language changes .
DSM-5-TR Criteria: Neurocognitive Disorder with Lewy Bodies requires cognitive decline plus at
least two core features: fluctuating cognition, recurrent visual hallucinations, or spontaneous
parkinsonism.
SECTION 3: PSYCHOTIC DISORDERS & MEDICATION SAFETY
Question 4
A 38-year-old patient with schizophrenia has been taking haloperidol for 8 years. During a
routine visit, you observe involuntary lip smacking, tongue protrusion, and grimacing
movements. The patient is unaware of these movements.
What is the most likely diagnosis and appropriate initial action?
A. Acute dystonia; administer benztropine
B. Parkinsonism; administer amantadine
C. Tardive dyskinesia; document and discuss with provider
D. Akathisia; reduce antipsychotic dose
Correct Answer: C
Rationale: Tardive dyskinesia is a late-onset extrapyramidal symptom characterized by
involuntary movements of the face, tongue, and extremities (lip smacking, tongue protrusion,
grimacing). It is associated with long-term use of first-generation antipsychotics (haloperidol).
QUESTIONS & DETAILED RATIONALES
DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH
ACROSS THE LIFESPAN PRACTICUM | CHAMBERLAIN
UNIVERSITY
SECTION 1: MOOD DISORDERS
Question 1
A 28-year-old graduate student presents with a 3-week history of pervasive low mood,
anhedonia, 10-lb weight loss, and insomnia with early morning awakening. She endorses
passive suicidal ideation but has no plan. She reports a similar but milder episode at age 19.
During the interview, you note her speech is pressured, she is distractible, and she reveals she
has been working on multiple creative projects simultaneously for the past 5 days, feeling "like
my brain is on fire and I don't need sleep."
What is the most accurate initial diagnosis?
A. Major Depressive Disorder, single episode, severe
B. Bipolar I Disorder, current episode depressed
C. Bipolar II Disorder, current episode depressed
D. Cyclothymic Disorder
Correct Answer: C
,Rationale: The patient meets criteria for a current Major Depressive Episode (depressed mood,
anhedonia, weight loss, insomnia, suicidal ideation). The critical diagnostic feature is the
reported 5-day period of hypomanic symptoms (decreased need for sleep, increased goal-
directed activity, distractibility, racing thoughts). A full manic episode (Bipolar I) would require
at least 7 days of symptoms causing marked impairment or requiring hospitalization; this
vignette describes hypomania (≥4 days, no marked impairment). Therefore, the history of a
major depressive episode and at least one hypomanic episode establishes Bipolar II Disorder.
Cyclothymia involves hypomanic and depressive symptoms that do not meet full episode
criteria .
Key Distinction: Bipolar II requires at least one major depressive episode and one hypomanic
episode. Bipolar I requires a full manic episode (which may have psychotic features or require
hospitalization).
Question 2
A 45-year-old veteran presents with his wife. She reports he is emotionally distant, irritable,
and has severe insomnia with nightmares. He startles excessively, avoids crowded places, and
has not visited friends since returning from deployment 10 months ago. He denies depressed
mood but admits to constant hypervigilance and feeling "numb inside." He meets full criteria
for PTSD. On mental status exam, you note a blunt affect, but he is fully oriented. His wife
mentions he has begun to repeatedly check that the stove is off before leaving the house, a
ritual that takes 30 minutes and causes arguments.
What is the most appropriate additional diagnosis to consider?
A. Illness Anxiety Disorder
B. Obsessive-Compulsive Disorder
C. Generalized Anxiety Disorder
D. Adjustment Disorder with Anxiety
,Correct Answer: B
Rationale: While OCD and PTSD are both trauma- and stressor-related disorders in DSM-5-TR,
they can be comorbid. The presence of true obsessions (recurrent, intrusive thoughts about the
stove being on leading to anxiety) and compulsions (the repetitive checking behavior
performed to neutralize the anxiety) that are time-consuming (30 minutes) and cause distress
meets criteria for OCD. The symptoms are not solely focused on the traumatic event,
differentiating them from PTSD symptoms (which would involve trauma-related triggers). GAD
would involve excessive worry about multiple events, not ritualistic behaviors .
Clinical Pearl: Always assess for comorbid OCD in PTSD patients; the obsessions in OCD are ego-
dystonic and not trauma-specific.
SECTION 2: NEUROCOGNITIVE DISORDERS
Question 3
A 72-year-old man with hypertension and type 2 diabetes is brought in by his daughter for
"confusion." Over the past 18 months, he has had a progressive decline in his ability to manage
finances and medications. He recently got lost driving to the grocery store. His MMSE score is
22/30, with deficits in orientation, recall, and visuospatial tasks (cannot copy intersecting
pentagons). His neurological exam is notable for mild asymmetric rigidity and a shuffling gait.
He has no tremor.
Which neurocognitive disorder is most likely?
A. Alzheimer's Disease
B. Vascular Neurocognitive Disorder
C. Neurocognitive Disorder with Lewy Bodies
D. Frontotemporal Neurocognitive Disorder
Correct Answer: C
, Rationale: The key features are progressive cognitive decline plus core features of Lewy Body
Dementia: spontaneous parkinsonism (rigidity, gait disturbance) and prominent visuospatial
deficits. The absence of tremor and the presence of early visuospatial and attentional deficits
help differentiate it from Parkinson's Disease Dementia (which would have motor symptoms
preceding cognitive decline by a year or more). Alzheimer's typically presents with early
memory impairment; vascular NCD would show a stepwise decline and focal neurological signs;
FTD presents with early personality/behavior or language changes .
DSM-5-TR Criteria: Neurocognitive Disorder with Lewy Bodies requires cognitive decline plus at
least two core features: fluctuating cognition, recurrent visual hallucinations, or spontaneous
parkinsonism.
SECTION 3: PSYCHOTIC DISORDERS & MEDICATION SAFETY
Question 4
A 38-year-old patient with schizophrenia has been taking haloperidol for 8 years. During a
routine visit, you observe involuntary lip smacking, tongue protrusion, and grimacing
movements. The patient is unaware of these movements.
What is the most likely diagnosis and appropriate initial action?
A. Acute dystonia; administer benztropine
B. Parkinsonism; administer amantadine
C. Tardive dyskinesia; document and discuss with provider
D. Akathisia; reduce antipsychotic dose
Correct Answer: C
Rationale: Tardive dyskinesia is a late-onset extrapyramidal symptom characterized by
involuntary movements of the face, tongue, and extremities (lip smacking, tongue protrusion,
grimacing). It is associated with long-term use of first-generation antipsychotics (haloperidol).
