NR 547 MENTAL HEALTH NURSING
FINAL EXAM PREP 2026
QUESTIONS, ANSWERS & RATIONALES
SECTION: DIFFERENTIAL DIAGNOSIS & DIAGNOSTIC
REASONING
Q1. A 27-year-old female presents with a 3-week history of persistent depressed mood,
anhedonia, 10-lb weight loss, and insomnia. She reports constant fatigue and feelings
of worthlessness. Her medical history is significant for Graves' disease, diagnosed 6
months ago, for which she takes methimazole. Her TSH is 0.02 mIU/L (low) and Free T4
is 3.2 ng/dL (high). What is the most appropriate initial diagnostic consideration?
A. Major Depressive Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Depressive Disorder Due to Another Medical Condition (Hyperthyroidism)
✅ Correct Answer: D
Rationale: While the symptoms meet criteria for a Major Depressive Episode, the primary rule-
out is a mood disorder due to a general medical condition. The patient has active, untreated
hyperthyroidism, which is a known potent cause of neuropsychiatric symptoms including
depression, anxiety, insomnia, and fatigue. DSM-5-TR requires considering the etiological
relationship; treatment of the hyperthyroidism must precede or coincide with the definitive
diagnosis of a primary depressive disorder.
Key Takeaway: Always rule out medical causes (thyroid dysfunction, vitamin deficiencies,
neurologic conditions) before diagnosing primary psychiatric disorders.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 1
,Q2. A 34-year-old patient presents with a chief complaint of "feeling on edge and unable
to sleep for the past month." The PMHNP begins formulating a working list of potential
conditions that could explain these symptoms. This initial hypothesis is BEST
described as:
A. Final diagnosis
B. Differential diagnosis
C. Prognostic indicator
D. Treatment algorithm
✅ Correct Answer: B
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. This is a critical
clinical reasoning process where the PMHNP systematically considers various conditions that
could explain the patient's symptoms before narrowing down to a final diagnosis.
Q3. A 16-year-old male is brought in by his parents due to increasing social isolation
and declining grades over the past 8 months. He spends all his time in his room on the
computer, has a flat affect, and makes poor eye contact. He reports that he sometimes
hears a voice commenting on his actions when no one is there. Which conditions must
be considered in the differential diagnosis before diagnosing Schizophrenia? (Select All
That Apply)
A. Autism Spectrum Disorder
B. Major Depressive Disorder with Psychotic Features
C. Substance-Induced Psychotic Disorder (e.g., from cannabis)
D. Schizotypal Personality Disorder
✅ Correct Answer: A, B, C, D
Rationale: In an adolescent, the differential for psychotic symptoms is broad. ASD can present
with social deficits and may include psychotic-like experiences. Depression with psychotic
features is a high-risk condition in teens. Substance use, particularly cannabis, is a common
cause of psychosis in this age group. Schizotypal PD involves perceptual distortions and social
isolation. A diagnosis of Schizophrenia requires ruling out these conditions and observing
symptoms for a significant portion of time during a 6-month period.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 2
,Q4. The diagnostic process in psychiatric-mental health requires processing client
information in a logical, progressive manner. Which of the following is the MOST
appropriate sequence for formulating a differential diagnosis?
A. Diagnosis → Assessment → Data Collection → Treatment Planning
B. Data Collection → Assessment → Differential Diagnosis Formulation → Treatment Planning
C. Treatment Planning → Data Collection → Assessment → Diagnosis
D. Assessment → Treatment Planning → Data Collection → Diagnosis
✅ Correct Answer: B
Rationale: The NR547 course emphasizes processing client information in a logical,
progressive manner when formulating differential diagnoses. Data collection includes
psychiatric history, mental status examination, collateral information, and relevant medical
workup. Assessment involves analyzing this data to identify symptom patterns. The differential
diagnosis is then formulated as a working list, which guides evidence-based treatment
planning.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 3
, SECTION: NEUROBIOLOGIC FOUNDATIONS &
NEUROTRANSMITTER SYSTEMS
Q5. A patient with major depressive disorder is started on an SSRI. The therapeutic
mechanism of action for SSRIs primarily involves:
A. Blockade of dopamine D2 receptors
B. Inhibition of serotonin reuptake at the synaptic cleft
C. Enhancement of GABA-A receptor activity
D. Antagonism of norepinephrine alpha-2 receptors
✅ Correct Answer: B
Rationale: SSRIs (Selective Serotonin Reuptake Inhibitors) work by blocking the serotonin
transporter (SERT), which prevents the reuptake of serotonin from the synaptic cleft back into
the presynaptic neuron. This increases the concentration of serotonin available to bind to
postsynaptic receptors, enhancing serotonergic neurotransmission. SSRIs typically take 2–6
weeks to achieve full therapeutic effect due to downstream adaptive changes.
Q6. Neurotransmitter dysregulation in depression involves multiple systems. Which
combination of neurotransmitter abnormalities is MOST commonly associated with
depressive disorders?
A. Increased dopamine and decreased GABA
B. Decreased serotonin, decreased norepinephrine, and decreased dopamine
C. Increased serotonin and increased glutamate
D. Decreased acetylcholine and increased histamine
✅ Correct Answer: B
Rationale: The monoamine hypothesis of depression proposes that depressive symptoms
result from deficiencies in one or more monoamine neurotransmitters: serotonin (5-HT),
norepinephrine (NE), and dopamine (DA). Serotonin dysregulation is associated with mood,
anxiety, and sleep disturbances; norepinephrine dysregulation is linked to energy, attention,
and psychomotor function; and dopamine dysregulation is implicated in anhedonia and
motivation deficits.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 4
FINAL EXAM PREP 2026
QUESTIONS, ANSWERS & RATIONALES
SECTION: DIFFERENTIAL DIAGNOSIS & DIAGNOSTIC
REASONING
Q1. A 27-year-old female presents with a 3-week history of persistent depressed mood,
anhedonia, 10-lb weight loss, and insomnia. She reports constant fatigue and feelings
of worthlessness. Her medical history is significant for Graves' disease, diagnosed 6
months ago, for which she takes methimazole. Her TSH is 0.02 mIU/L (low) and Free T4
is 3.2 ng/dL (high). What is the most appropriate initial diagnostic consideration?
A. Major Depressive Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Depressive Disorder Due to Another Medical Condition (Hyperthyroidism)
✅ Correct Answer: D
Rationale: While the symptoms meet criteria for a Major Depressive Episode, the primary rule-
out is a mood disorder due to a general medical condition. The patient has active, untreated
hyperthyroidism, which is a known potent cause of neuropsychiatric symptoms including
depression, anxiety, insomnia, and fatigue. DSM-5-TR requires considering the etiological
relationship; treatment of the hyperthyroidism must precede or coincide with the definitive
diagnosis of a primary depressive disorder.
Key Takeaway: Always rule out medical causes (thyroid dysfunction, vitamin deficiencies,
neurologic conditions) before diagnosing primary psychiatric disorders.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 1
,Q2. A 34-year-old patient presents with a chief complaint of "feeling on edge and unable
to sleep for the past month." The PMHNP begins formulating a working list of potential
conditions that could explain these symptoms. This initial hypothesis is BEST
described as:
A. Final diagnosis
B. Differential diagnosis
C. Prognostic indicator
D. Treatment algorithm
✅ Correct Answer: B
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. This is a critical
clinical reasoning process where the PMHNP systematically considers various conditions that
could explain the patient's symptoms before narrowing down to a final diagnosis.
Q3. A 16-year-old male is brought in by his parents due to increasing social isolation
and declining grades over the past 8 months. He spends all his time in his room on the
computer, has a flat affect, and makes poor eye contact. He reports that he sometimes
hears a voice commenting on his actions when no one is there. Which conditions must
be considered in the differential diagnosis before diagnosing Schizophrenia? (Select All
That Apply)
A. Autism Spectrum Disorder
B. Major Depressive Disorder with Psychotic Features
C. Substance-Induced Psychotic Disorder (e.g., from cannabis)
D. Schizotypal Personality Disorder
✅ Correct Answer: A, B, C, D
Rationale: In an adolescent, the differential for psychotic symptoms is broad. ASD can present
with social deficits and may include psychotic-like experiences. Depression with psychotic
features is a high-risk condition in teens. Substance use, particularly cannabis, is a common
cause of psychosis in this age group. Schizotypal PD involves perceptual distortions and social
isolation. A diagnosis of Schizophrenia requires ruling out these conditions and observing
symptoms for a significant portion of time during a 6-month period.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 2
,Q4. The diagnostic process in psychiatric-mental health requires processing client
information in a logical, progressive manner. Which of the following is the MOST
appropriate sequence for formulating a differential diagnosis?
A. Diagnosis → Assessment → Data Collection → Treatment Planning
B. Data Collection → Assessment → Differential Diagnosis Formulation → Treatment Planning
C. Treatment Planning → Data Collection → Assessment → Diagnosis
D. Assessment → Treatment Planning → Data Collection → Diagnosis
✅ Correct Answer: B
Rationale: The NR547 course emphasizes processing client information in a logical,
progressive manner when formulating differential diagnoses. Data collection includes
psychiatric history, mental status examination, collateral information, and relevant medical
workup. Assessment involves analyzing this data to identify symptom patterns. The differential
diagnosis is then formulated as a working list, which guides evidence-based treatment
planning.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 3
, SECTION: NEUROBIOLOGIC FOUNDATIONS &
NEUROTRANSMITTER SYSTEMS
Q5. A patient with major depressive disorder is started on an SSRI. The therapeutic
mechanism of action for SSRIs primarily involves:
A. Blockade of dopamine D2 receptors
B. Inhibition of serotonin reuptake at the synaptic cleft
C. Enhancement of GABA-A receptor activity
D. Antagonism of norepinephrine alpha-2 receptors
✅ Correct Answer: B
Rationale: SSRIs (Selective Serotonin Reuptake Inhibitors) work by blocking the serotonin
transporter (SERT), which prevents the reuptake of serotonin from the synaptic cleft back into
the presynaptic neuron. This increases the concentration of serotonin available to bind to
postsynaptic receptors, enhancing serotonergic neurotransmission. SSRIs typically take 2–6
weeks to achieve full therapeutic effect due to downstream adaptive changes.
Q6. Neurotransmitter dysregulation in depression involves multiple systems. Which
combination of neurotransmitter abnormalities is MOST commonly associated with
depressive disorders?
A. Increased dopamine and decreased GABA
B. Decreased serotonin, decreased norepinephrine, and decreased dopamine
C. Increased serotonin and increased glutamate
D. Decreased acetylcholine and increased histamine
✅ Correct Answer: B
Rationale: The monoamine hypothesis of depression proposes that depressive symptoms
result from deficiencies in one or more monoamine neurotransmitters: serotonin (5-HT),
norepinephrine (NE), and dopamine (DA). Serotonin dysregulation is associated with mood,
anxiety, and sleep disturbances; norepinephrine dysregulation is linked to energy, attention,
and psychomotor function; and dopamine dysregulation is implicated in anhedonia and
motivation deficits.
NR 547 Mental Health Nursing Final Exam Prep 2026 | 4
