NR 547 Mental Health Nursing — Final Exam Study Guide 2026
NR 547 FINAL EXAM STUDY GUIDE 2026
MENTAL HEALTH NURSING — COMPREHENSIVE REVIEW
QUESTIONS, ANSWERS & RATIONALES
Formatted for consistent study, editing, and printing. Source content preserved; choices are shown only
where the source supplied them.
Foundations of Differential Diagnosis
Q1. A 24-year-old college student presents with new-onset auditory hallucinations and
paranoia. What is the PMHNP’s most appropriate first step in the differential diagnosis
process?
A. Prescribe a second-generation antipsychotic.
B. Assess for a history of childhood trauma.
C. Order a urine toxicology screen and basic metabolic panel.
D. Diagnose schizophrenia and refer for cognitive behavioral therapy.
Correct Answer: C
Rationale: The first step in any new-onset psychiatric presentation, especially psychosis, is to
rule out general medical conditions and substance-induced etiologies.
Mood Disorders
Q2. A 35-year-old patient presents with severe depressive symptoms. During the interview,
they mention that 3 years ago, they went 5 days without sleeping, spent $10,000 on credit
cards, and felt "invincible," but did not seek treatment. What is the most accurate
diagnosis?
A. Major Depressive Disorder, recurrent
B. Bipolar I Disorder
C. Bipolar II Disorder
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, NR 547 Mental Health Nursing — Final Exam Study Guide 2026
D. Cyclothymic Disorder
Correct Answer: B
Rationale: The patient’s history of going 5 days without sleep, grandiosity ("invincible"), and
reckless spending meets the criteria for a manic episode (lasting ≥7 days or requiring
hospitalization, or causing severe impairment). A single manic episode is sufficient for a Bipolar I
diagnosis, even if the current presentation is depression
Neurocognitive Disorders
Q3. An 82-year-old patient is brought to the clinic by their daughter, who reports a sudden
onset of confusion, agitation, and visual hallucinations over the past 2 days. The patient’s
attention waxes and wanes during the interview. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Major Depressive Disorder with psychotic features
D. Vascular Neurocognitive Disorder
Correct Answer: B
Rationale: Delirium is characterized by an acute onset, fluctuating level of consciousness, and
impaired attention
Trauma and Stressor-Related Disorders
Q4. A patient reports experiencing a motor vehicle accident 3 weeks ago. Since then, they
have had intrusive memories, nightmares, and severe anxiety, avoiding driving altogether.
What is the most appropriate diagnosis at this time?
A. Post-Traumatic Stress Disorder (PTSD)
B. Acute Stress Disorder (ASD)
C. Adjustment Disorder with Anxiety
D. Panic Disorder
Correct Answer: B
Rationale: The differentiating factor between ASD and PTSD is time
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, NR 547 Mental Health Nursing — Final Exam Study Guide 2026
Psychotic Disorders
Q5. A patient has a 2-year history of major depressive episodes. They also report
experiencing auditory hallucinations and delusions for a total of 8 months during this period.
Crucially, there was a 3-week period where the hallucinations persisted without any
depressive symptoms. What is the most accurate diagnosis?
A. Major Depressive Disorder with psychotic features
B. Schizophrenia
C. Schizoaffective Disorder
D. Schizophreniform Disorder
Correct Answer: C
Rationale: Schizoaffective disorder requires that delusions or hallucinations occur for at least 2
weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration
of the illness.
Neurodevelopmental Disorders
Q6. A 10-year-old child is brought in for hyperactivity and poor school performance. The
mother reports the behaviors started at age 8. The child’s teacher confirms the behaviors are
present in the classroom. What additional criterion must be met to diagnose ADHD?
A. Symptoms must be present in at least two settings (e.g., home and school).
B. Symptoms must have been present before age 18.
C. The child must have a comorbid learning disability.
D. Symptoms must be worse in the morning than in the evening.
Correct Answer: A
Rationale: DSM-5-TR criteria for ADHD require that several symptoms be present in two or more
settings (e.g., home, school, work) and that there be clear evidence of interference with
functioning
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, NR 547 Mental Health Nursing — Final Exam Study Guide 2026
Factitious Disorder vs. Malingering
Q7. A patient with a history of multiple hospitalizations presents with recurrent, unexplained
hypoglycemia. Nursing staff observe the patient self-administering insulin from a hidden
syringe. When confronted, the patient admits to doing it because they "like the attention and
care from the medical staff." There is no request for disability payments or time off work.
What is the most likely diagnosis?
A. Malingering
B. Factitious Disorder Imposed on Self
C. Somatic Symptom Disorder
D. Illness Anxiety Disorder
Correct Answer: B
Rationale: Factitious disorder involves the intentional falsification or induction of
signs/symptoms to assume the "sick role" (primary gain) without obvious external rewards
Geriatric Mental Health
Q8. An older adult presents with memory complaints, slowed thinking, and poor
concentration. Cognitive testing shows poor effort, but the patient frequently answers "I
don't know" rather than attempting to confabulate or guess. What is the PMHNP’s primary
differential consideration?
A. Frontotemporal Dementia
B. Pseudodementia secondary to Major Depressive Disorder
C. Normal age-related cognitive decline
D. Lewy Body Dementia
Correct Answer: B
Rationale: Geriatric depression often presents as "pseudodementia," characterized by cognitive
complaints, psychomotor retardation, and a tendency to answer "I don't know" on cognitive tests
due to lack of effort or apathy, rather than true memory loss. Patients with true dementia typically
try to hide deficits or confabulate.
Page 4
NR 547 FINAL EXAM STUDY GUIDE 2026
MENTAL HEALTH NURSING — COMPREHENSIVE REVIEW
QUESTIONS, ANSWERS & RATIONALES
Formatted for consistent study, editing, and printing. Source content preserved; choices are shown only
where the source supplied them.
Foundations of Differential Diagnosis
Q1. A 24-year-old college student presents with new-onset auditory hallucinations and
paranoia. What is the PMHNP’s most appropriate first step in the differential diagnosis
process?
A. Prescribe a second-generation antipsychotic.
B. Assess for a history of childhood trauma.
C. Order a urine toxicology screen and basic metabolic panel.
D. Diagnose schizophrenia and refer for cognitive behavioral therapy.
Correct Answer: C
Rationale: The first step in any new-onset psychiatric presentation, especially psychosis, is to
rule out general medical conditions and substance-induced etiologies.
Mood Disorders
Q2. A 35-year-old patient presents with severe depressive symptoms. During the interview,
they mention that 3 years ago, they went 5 days without sleeping, spent $10,000 on credit
cards, and felt "invincible," but did not seek treatment. What is the most accurate
diagnosis?
A. Major Depressive Disorder, recurrent
B. Bipolar I Disorder
C. Bipolar II Disorder
Page 1
, NR 547 Mental Health Nursing — Final Exam Study Guide 2026
D. Cyclothymic Disorder
Correct Answer: B
Rationale: The patient’s history of going 5 days without sleep, grandiosity ("invincible"), and
reckless spending meets the criteria for a manic episode (lasting ≥7 days or requiring
hospitalization, or causing severe impairment). A single manic episode is sufficient for a Bipolar I
diagnosis, even if the current presentation is depression
Neurocognitive Disorders
Q3. An 82-year-old patient is brought to the clinic by their daughter, who reports a sudden
onset of confusion, agitation, and visual hallucinations over the past 2 days. The patient’s
attention waxes and wanes during the interview. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Major Depressive Disorder with psychotic features
D. Vascular Neurocognitive Disorder
Correct Answer: B
Rationale: Delirium is characterized by an acute onset, fluctuating level of consciousness, and
impaired attention
Trauma and Stressor-Related Disorders
Q4. A patient reports experiencing a motor vehicle accident 3 weeks ago. Since then, they
have had intrusive memories, nightmares, and severe anxiety, avoiding driving altogether.
What is the most appropriate diagnosis at this time?
A. Post-Traumatic Stress Disorder (PTSD)
B. Acute Stress Disorder (ASD)
C. Adjustment Disorder with Anxiety
D. Panic Disorder
Correct Answer: B
Rationale: The differentiating factor between ASD and PTSD is time
Page 2
, NR 547 Mental Health Nursing — Final Exam Study Guide 2026
Psychotic Disorders
Q5. A patient has a 2-year history of major depressive episodes. They also report
experiencing auditory hallucinations and delusions for a total of 8 months during this period.
Crucially, there was a 3-week period where the hallucinations persisted without any
depressive symptoms. What is the most accurate diagnosis?
A. Major Depressive Disorder with psychotic features
B. Schizophrenia
C. Schizoaffective Disorder
D. Schizophreniform Disorder
Correct Answer: C
Rationale: Schizoaffective disorder requires that delusions or hallucinations occur for at least 2
weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration
of the illness.
Neurodevelopmental Disorders
Q6. A 10-year-old child is brought in for hyperactivity and poor school performance. The
mother reports the behaviors started at age 8. The child’s teacher confirms the behaviors are
present in the classroom. What additional criterion must be met to diagnose ADHD?
A. Symptoms must be present in at least two settings (e.g., home and school).
B. Symptoms must have been present before age 18.
C. The child must have a comorbid learning disability.
D. Symptoms must be worse in the morning than in the evening.
Correct Answer: A
Rationale: DSM-5-TR criteria for ADHD require that several symptoms be present in two or more
settings (e.g., home, school, work) and that there be clear evidence of interference with
functioning
Page 3
, NR 547 Mental Health Nursing — Final Exam Study Guide 2026
Factitious Disorder vs. Malingering
Q7. A patient with a history of multiple hospitalizations presents with recurrent, unexplained
hypoglycemia. Nursing staff observe the patient self-administering insulin from a hidden
syringe. When confronted, the patient admits to doing it because they "like the attention and
care from the medical staff." There is no request for disability payments or time off work.
What is the most likely diagnosis?
A. Malingering
B. Factitious Disorder Imposed on Self
C. Somatic Symptom Disorder
D. Illness Anxiety Disorder
Correct Answer: B
Rationale: Factitious disorder involves the intentional falsification or induction of
signs/symptoms to assume the "sick role" (primary gain) without obvious external rewards
Geriatric Mental Health
Q8. An older adult presents with memory complaints, slowed thinking, and poor
concentration. Cognitive testing shows poor effort, but the patient frequently answers "I
don't know" rather than attempting to confabulate or guess. What is the PMHNP’s primary
differential consideration?
A. Frontotemporal Dementia
B. Pseudodementia secondary to Major Depressive Disorder
C. Normal age-related cognitive decline
D. Lewy Body Dementia
Correct Answer: B
Rationale: Geriatric depression often presents as "pseudodementia," characterized by cognitive
complaints, psychomotor retardation, and a tendency to answer "I don't know" on cognitive tests
due to lack of effort or apathy, rather than true memory loss. Patients with true dementia typically
try to hide deficits or confabulate.
Page 4
