NR 547 Final Exam 2025/2026 Test Bank |
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 32-year-old woman reports a 3-week period of pervasive
low mood, anhedonia, insomnia, weight loss of 6 lbs, and
recurrent passive suicidal ideation without intent. She
previously had a 3-day episode of markedly elevated mood
following a bereavement two years ago that did not impair
functioning. Which diagnosis is most consistent?
A. Major depressive disorder, single episode
B. Persistent depressive disorder (dysthymia)
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
,Correct Answer: A
Rationale: DSM-5-TR requires ≥2 weeks for a major depressive
episode; symptoms here are 3 weeks with typical MDE
symptoms (anhedonia, weight change, insomnia, SI). Persistent
depressive disorder requires ≥2 years. Bipolar II requires
hypomanic episodes (≥4 days) and recurrent major depression;
a 3-day elevation is insufficient for hypomania. Adjustment
disorder is time-limited to stressor-related distress that does
not meet criteria for MDE.
Q2. A 45-year-old man presents with 8 months of excessive
worry about multiple domains (work, finances, health)
occurring more days than not, difficulty controlling worry,
restlessness, muscle tension, and impaired concentration. No
panic attacks or photophobia. Which finding best differentiates
generalized anxiety disorder (GAD) from an anxiety disorder
secondary to hyperthyroidism?
A. Duration of symptoms >6 months
B. Presence of muscle tension and restlessness
C. Normal thyroid-stimulating hormone (TSH) level
D. Excessive worry about multiple domains
Correct Answer: C
Rationale: DSM-5-TR GAD requires ≥6 months of excessive
anxiety and worry; clinical features overlap with
hyperthyroidism. A normal TSH rules out a common medical
cause, supporting primary GAD. Duration and symptom cluster
,support GAD but do not exclude medical causes. Lab
confirmation is key for differential diagnosis.
Q3. A 25-year-old combat veteran experiences intrusive
memories, nightmares, hypervigilance, emotional numbing, and
avoidance for 2 months following traumatic exposure. He meets
full PTSD criteria. Which feature distinguishes PTSD from
adjustment disorder?
A. Exposure to a traumatic event involving actual/threatened
death or serious injury
B. Symptoms causing clinically significant distress
C. Onset within 3 months of the stressor
D. Symptoms do not meet criteria for another mental disorder
Correct Answer: A
Rationale: DSM-5-TR PTSD requires exposure to
actual/threatened death/serious injury (Criterion A).
Adjustment disorder does not require trauma-level exposure.
Distress and timing can be similar; trauma exposure is the key
distinguishing criterion.
Q4. An adolescent presents with auditory hallucinations,
disorganized speech, and decline in school performance for 3
weeks. There was a recent high-dose cannabis binge 5 days ago.
Which diagnosis is most likely after acute intoxication is
excluded?
, A. Schizophrenia
B. Schizophreniform disorder
C. Substance/medication-induced psychotic disorder
D. Brief psychotic disorder
Correct Answer: C
Rationale: DSM-5-TR requires ruling out substance-induced
causes before primary psychotic diagnoses. Given recent high-
dose cannabis and temporal proximity, substance/medication-
induced psychotic disorder is most likely until symptoms persist
beyond intoxication/withdrawal and are not better explained
otherwise. Schizophrenia requires ≥6 months; schizophreniform
1–6 months; brief psychotic disorder <1 month but substance
link favors substance-induced.
Q5. An 80-year-old man has fluctuating consciousness,
disorientation, impaired attention, and an acute onset over 24
hours. He has a UTI and recently started an anticholinergic
medication. Which diagnosis is most consistent?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Delirium due to medical condition/medication
C. Mild neurocognitive disorder
D. Pseudodementia from depression
Correct Answer: B
Rationale: DSM-5-TR delirium is characterized by acute onset,
fluctuating course, impaired attention, and evidence of a
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 32-year-old woman reports a 3-week period of pervasive
low mood, anhedonia, insomnia, weight loss of 6 lbs, and
recurrent passive suicidal ideation without intent. She
previously had a 3-day episode of markedly elevated mood
following a bereavement two years ago that did not impair
functioning. Which diagnosis is most consistent?
A. Major depressive disorder, single episode
B. Persistent depressive disorder (dysthymia)
C. Bipolar II disorder
D. Adjustment disorder with depressed mood
,Correct Answer: A
Rationale: DSM-5-TR requires ≥2 weeks for a major depressive
episode; symptoms here are 3 weeks with typical MDE
symptoms (anhedonia, weight change, insomnia, SI). Persistent
depressive disorder requires ≥2 years. Bipolar II requires
hypomanic episodes (≥4 days) and recurrent major depression;
a 3-day elevation is insufficient for hypomania. Adjustment
disorder is time-limited to stressor-related distress that does
not meet criteria for MDE.
Q2. A 45-year-old man presents with 8 months of excessive
worry about multiple domains (work, finances, health)
occurring more days than not, difficulty controlling worry,
restlessness, muscle tension, and impaired concentration. No
panic attacks or photophobia. Which finding best differentiates
generalized anxiety disorder (GAD) from an anxiety disorder
secondary to hyperthyroidism?
A. Duration of symptoms >6 months
B. Presence of muscle tension and restlessness
C. Normal thyroid-stimulating hormone (TSH) level
D. Excessive worry about multiple domains
Correct Answer: C
Rationale: DSM-5-TR GAD requires ≥6 months of excessive
anxiety and worry; clinical features overlap with
hyperthyroidism. A normal TSH rules out a common medical
cause, supporting primary GAD. Duration and symptom cluster
,support GAD but do not exclude medical causes. Lab
confirmation is key for differential diagnosis.
Q3. A 25-year-old combat veteran experiences intrusive
memories, nightmares, hypervigilance, emotional numbing, and
avoidance for 2 months following traumatic exposure. He meets
full PTSD criteria. Which feature distinguishes PTSD from
adjustment disorder?
A. Exposure to a traumatic event involving actual/threatened
death or serious injury
B. Symptoms causing clinically significant distress
C. Onset within 3 months of the stressor
D. Symptoms do not meet criteria for another mental disorder
Correct Answer: A
Rationale: DSM-5-TR PTSD requires exposure to
actual/threatened death/serious injury (Criterion A).
Adjustment disorder does not require trauma-level exposure.
Distress and timing can be similar; trauma exposure is the key
distinguishing criterion.
Q4. An adolescent presents with auditory hallucinations,
disorganized speech, and decline in school performance for 3
weeks. There was a recent high-dose cannabis binge 5 days ago.
Which diagnosis is most likely after acute intoxication is
excluded?
, A. Schizophrenia
B. Schizophreniform disorder
C. Substance/medication-induced psychotic disorder
D. Brief psychotic disorder
Correct Answer: C
Rationale: DSM-5-TR requires ruling out substance-induced
causes before primary psychotic diagnoses. Given recent high-
dose cannabis and temporal proximity, substance/medication-
induced psychotic disorder is most likely until symptoms persist
beyond intoxication/withdrawal and are not better explained
otherwise. Schizophrenia requires ≥6 months; schizophreniform
1–6 months; brief psychotic disorder <1 month but substance
link favors substance-induced.
Q5. An 80-year-old man has fluctuating consciousness,
disorientation, impaired attention, and an acute onset over 24
hours. He has a UTI and recently started an anticholinergic
medication. Which diagnosis is most consistent?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Delirium due to medical condition/medication
C. Mild neurocognitive disorder
D. Pseudodementia from depression
Correct Answer: B
Rationale: DSM-5-TR delirium is characterized by acute onset,
fluctuating course, impaired attention, and evidence of a
