NR 547 FINAL STUDY GUIDE PMHNP
NR 547 DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN FINAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 34-year-old patient presents with a 3-week history of depressed mood,
diminished interest in previously enjoyable activities, insomnia, fatigue, feelings of
worthlessness, and difficulty concentrating. The patient denies psychotic
symptoms and denies any past episodes of unusually elevated or irritable mood.
Which finding is most important for establishing a diagnosis of major depressive
disorder?
A. Symptoms occur primarily in the morning
B. At least five depressive symptoms have occurred during the same 2-week
period, including depressed mood or anhedonia
C. The patient reports decreased appetite and a 5-lb weight loss
D. Symptoms have caused difficulty maintaining employment
Answer: B
Rationale: Major depressive disorder requires at least five symptoms during the
same 2-week period, representing a change from prior functioning, and at least one
symptom must be depressed mood or diminished interest or pleasure. Functional
impairment is important but does not substitute for the diagnostic symptom
criteria.
,Question 2
A 27-year-old woman is being evaluated for a first episode of depression. She
reports decreased sleep, low energy, hopelessness, and anhedonia. Before starting
an antidepressant, the PMHNP asks whether she has ever experienced a period in
which she needed very little sleep, talked much more than usual, felt unusually
confident, or engaged in excessive goal-directed activity. What is the primary
reason for this assessment?
A. To determine whether generalized anxiety disorder is present
B. To identify possible bipolar-spectrum illness before initiating antidepressant
therapy
C. To determine whether an MAOI is contraindicated
D. To establish the severity of the current depressive episode
Answer: B
Rationale: A history of mania or hypomania is critical when evaluating
depression. Treating an individual with bipolar disorder as though the illness were
unipolar depression can precipitate mania, hypomania, or mood destabilization in
some patients.
Question 3
A 61-year-old patient reports feeling “down most days” for approximately 3 years.
The patient continues working and has never gone longer than 6 weeks without
depressive symptoms. There has not been a distinct period of mania or hypomania.
Which diagnosis should be strongly considered?
A. Persistent depressive disorder
B. Cyclothymic disorder
C. Bipolar II disorder
D. Premenstrual dysphoric disorder
Answer: A
Rationale: Persistent depressive disorder is characterized by depressed mood for
more days than not for at least 2 years in adults, with no symptom-free period
,longer than 2 months. The chronicity of this presentation distinguishes it from an
isolated major depressive episode.
Question 4
During an evaluation for depression, a 42-year-old patient reports episodes of
spending excessively, sleeping only 3 hours nightly without feeling tired, speaking
rapidly, and becoming unusually productive. These periods lasted approximately 5
days and were clearly different from the patient's usual behavior. Which screening
instrument would provide additional information about a possible bipolar-spectrum
disorder?
A. PHQ-9
B. Geriatric Depression Scale
C. Mood Disorder Questionnaire
D. PANSS
Answer: C
Rationale: The Mood Disorder Questionnaire is designed to screen for a history
suggestive of bipolar-spectrum symptoms. It does not establish the diagnosis by
itself, but it can identify patients who require a more detailed assessment of manic
or hypomanic episodes.
Question 5
A 45-year-old patient presents with fatigue, slowed thinking, constipation, weight
gain, and depressed mood. The patient has no prior psychiatric history. Which
laboratory evaluation is particularly important before concluding that the
symptoms represent a primary depressive disorder?
A. Serum amylase
B. Thyroid function testing
C. Serum troponin
D. Serum lipase
Answer: B
, Rationale: Hypothyroidism can closely mimic depressive illness, producing
fatigue, cognitive slowing, weight gain, and depressed mood. Thyroid-stimulating
hormone and free thyroxine are commonly included when evaluating possible
medical contributors to depressive symptoms.
Question 6
A 72-year-old patient reports low mood and loss of interest. A short-form Geriatric
Depression Scale is administered and produces a score of 7. How should the
PMHNP interpret this result?
A. No evidence of depressive symptoms
B. Mild depressive symptoms requiring further clinical evaluation
C. Severe depression requiring immediate hospitalization
D. Definitive confirmation of major depressive disorder
Answer: B
Rationale: On the 15-item short-form Geriatric Depression Scale, a score of 5 or
greater suggests depressive symptoms and should prompt further evaluation. A
screening score does not independently establish a DSM diagnosis or determine the
need for hospitalization.
Question 7
A 29-year-old patient with depression asks which medication class is generally
considered first-line pharmacotherapy for unipolar major depressive disorder
because of its efficacy, tolerability, and broad clinical use.
A. Monoamine oxidase inhibitors
B. Tricyclic antidepressants
C. Selective serotonin reuptake inhibitors
D. Barbiturates
Answer: C
NR 547 DIFFERENTIAL DIAGNOSIS IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN FINAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A 34-year-old patient presents with a 3-week history of depressed mood,
diminished interest in previously enjoyable activities, insomnia, fatigue, feelings of
worthlessness, and difficulty concentrating. The patient denies psychotic
symptoms and denies any past episodes of unusually elevated or irritable mood.
Which finding is most important for establishing a diagnosis of major depressive
disorder?
A. Symptoms occur primarily in the morning
B. At least five depressive symptoms have occurred during the same 2-week
period, including depressed mood or anhedonia
C. The patient reports decreased appetite and a 5-lb weight loss
D. Symptoms have caused difficulty maintaining employment
Answer: B
Rationale: Major depressive disorder requires at least five symptoms during the
same 2-week period, representing a change from prior functioning, and at least one
symptom must be depressed mood or diminished interest or pleasure. Functional
impairment is important but does not substitute for the diagnostic symptom
criteria.
,Question 2
A 27-year-old woman is being evaluated for a first episode of depression. She
reports decreased sleep, low energy, hopelessness, and anhedonia. Before starting
an antidepressant, the PMHNP asks whether she has ever experienced a period in
which she needed very little sleep, talked much more than usual, felt unusually
confident, or engaged in excessive goal-directed activity. What is the primary
reason for this assessment?
A. To determine whether generalized anxiety disorder is present
B. To identify possible bipolar-spectrum illness before initiating antidepressant
therapy
C. To determine whether an MAOI is contraindicated
D. To establish the severity of the current depressive episode
Answer: B
Rationale: A history of mania or hypomania is critical when evaluating
depression. Treating an individual with bipolar disorder as though the illness were
unipolar depression can precipitate mania, hypomania, or mood destabilization in
some patients.
Question 3
A 61-year-old patient reports feeling “down most days” for approximately 3 years.
The patient continues working and has never gone longer than 6 weeks without
depressive symptoms. There has not been a distinct period of mania or hypomania.
Which diagnosis should be strongly considered?
A. Persistent depressive disorder
B. Cyclothymic disorder
C. Bipolar II disorder
D. Premenstrual dysphoric disorder
Answer: A
Rationale: Persistent depressive disorder is characterized by depressed mood for
more days than not for at least 2 years in adults, with no symptom-free period
,longer than 2 months. The chronicity of this presentation distinguishes it from an
isolated major depressive episode.
Question 4
During an evaluation for depression, a 42-year-old patient reports episodes of
spending excessively, sleeping only 3 hours nightly without feeling tired, speaking
rapidly, and becoming unusually productive. These periods lasted approximately 5
days and were clearly different from the patient's usual behavior. Which screening
instrument would provide additional information about a possible bipolar-spectrum
disorder?
A. PHQ-9
B. Geriatric Depression Scale
C. Mood Disorder Questionnaire
D. PANSS
Answer: C
Rationale: The Mood Disorder Questionnaire is designed to screen for a history
suggestive of bipolar-spectrum symptoms. It does not establish the diagnosis by
itself, but it can identify patients who require a more detailed assessment of manic
or hypomanic episodes.
Question 5
A 45-year-old patient presents with fatigue, slowed thinking, constipation, weight
gain, and depressed mood. The patient has no prior psychiatric history. Which
laboratory evaluation is particularly important before concluding that the
symptoms represent a primary depressive disorder?
A. Serum amylase
B. Thyroid function testing
C. Serum troponin
D. Serum lipase
Answer: B
, Rationale: Hypothyroidism can closely mimic depressive illness, producing
fatigue, cognitive slowing, weight gain, and depressed mood. Thyroid-stimulating
hormone and free thyroxine are commonly included when evaluating possible
medical contributors to depressive symptoms.
Question 6
A 72-year-old patient reports low mood and loss of interest. A short-form Geriatric
Depression Scale is administered and produces a score of 7. How should the
PMHNP interpret this result?
A. No evidence of depressive symptoms
B. Mild depressive symptoms requiring further clinical evaluation
C. Severe depression requiring immediate hospitalization
D. Definitive confirmation of major depressive disorder
Answer: B
Rationale: On the 15-item short-form Geriatric Depression Scale, a score of 5 or
greater suggests depressive symptoms and should prompt further evaluation. A
screening score does not independently establish a DSM diagnosis or determine the
need for hospitalization.
Question 7
A 29-year-old patient with depression asks which medication class is generally
considered first-line pharmacotherapy for unipolar major depressive disorder
because of its efficacy, tolerability, and broad clinical use.
A. Monoamine oxidase inhibitors
B. Tricyclic antidepressants
C. Selective serotonin reuptake inhibitors
D. Barbiturates
Answer: C
