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 35-year-old presents with 3 weeks of depressed mood,
anhedonia, insomnia, decreased appetite, and passive death
wishes. He reports increased alcohol intake since symptoms
began. Which diagnosis best fits DSM-5-TR criteria after
excluding medical causes?
A. Major Depressive Disorder, single episode
B. Substance/Medication-Induced Depressive Disorder
C. Adjustment Disorder with Depressed Mood
D. Persistent Depressive Disorder (Dysthymia)
,Correct Answer: A
Rationale: Symptoms meet duration (≥2 weeks) and symptom
count for a major depressive episode. Substance use began
after symptom onset, so substance-induced depression is less
likely unless direct temporal causation is shown. Adjustment
disorder is time-limited to stressor-related distress and usually
milder; dysthymia requires ≥2 years duration.
Q2. A 24-year-old with episodic elevated mood for 3 days with
increased goal-directed activity, decreased need for sleep,
pressured speech, but no psychotic features. Functioning is
impaired but not hospitalized. Best diagnosis?
A. Bipolar I Disorder, current manic episode
B. Bipolar II Disorder, hypomanic episode
C. Cyclothymic Disorder
D. Other Specified Bipolar and Related Disorder
Correct Answer: D
Rationale: DSM-5-TR requires ≥4 days for hypomania and ≥1
week for mania (unless hospitalization). A 3-day duration meets
neither; therefore "Other Specified Bipolar" fits when
symptoms are subthreshold in duration yet clinically significant.
Q3. Which set of features most strongly differentiates Bipolar I
with psychotic features from Schizoaffective Disorder, bipolar
type?
,A. Presence of hallucinations and delusions during mood
episodes only
B. A major mood episode present for majority of total illness
duration
C. Psychotic symptoms present for ≥2 weeks in the absence of
mood symptoms
D. Rapid cycling (>4 mood episodes/year)
Correct Answer: C
Rationale: Schizoaffective diagnosis requires ≥2 weeks of
psychosis without a major mood episode; if psychosis occurs
only during mood episodes, diagnosis favors mood disorder
with psychotic features (e.g., Bipolar I with psychotic features).
Q4. Select all that apply. Which findings most strongly support a
diagnosis of delirium rather than major neurocognitive disorder
(NCD)?
A. Acute onset over hours to days
B. Fluctuating level of consciousness and attention
C. Progressive decline over months with preserved attention
D. Reversible with treatment of underlying medical cause
Correct Answer: A, B, D
Rationale: Delirium is characterized by acute onset, fluctuating
attention/level of consciousness, and often reversibility when
the precipitant is treated. Progressive decline with preserved
attention is more consistent with major NCD.
, Q5. A 7-year-old displays temper outbursts that are grossly out
of proportion, occur daily, and persistent irritable mood
between outbursts for 12 months across settings. Which
diagnosis best fits?
A. Oppositional Defiant Disorder (ODD)
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Conduct Disorder
D. Bipolar Disorder, pediatric presentation
Correct Answer: B
Rationale: DMDD is defined by severe recurrent temper
outbursts, chronic persistent irritability between outbursts,
onset before age 10, and duration ≥12 months across settings.
ODD involves oppositional behavior but not the severe temper
outbursts and pervasive mood criterion.
Q6. A 68-year-old with Parkinson disease develops visual
hallucinations, cognitive fluctuations, and parkinsonism for 2
years. According to DSM-5-TR differential diagnosis, the most
appropriate diagnosis is:
A. Major Neurocognitive Disorder due to Alzheimer’s disease
B. Major Neurocognitive Disorder with Lewy bodies (DLB)
C. Parkinson's Disease with comorbid major NCD due to
Alzheimer’s
D. Delirium
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 35-year-old presents with 3 weeks of depressed mood,
anhedonia, insomnia, decreased appetite, and passive death
wishes. He reports increased alcohol intake since symptoms
began. Which diagnosis best fits DSM-5-TR criteria after
excluding medical causes?
A. Major Depressive Disorder, single episode
B. Substance/Medication-Induced Depressive Disorder
C. Adjustment Disorder with Depressed Mood
D. Persistent Depressive Disorder (Dysthymia)
,Correct Answer: A
Rationale: Symptoms meet duration (≥2 weeks) and symptom
count for a major depressive episode. Substance use began
after symptom onset, so substance-induced depression is less
likely unless direct temporal causation is shown. Adjustment
disorder is time-limited to stressor-related distress and usually
milder; dysthymia requires ≥2 years duration.
Q2. A 24-year-old with episodic elevated mood for 3 days with
increased goal-directed activity, decreased need for sleep,
pressured speech, but no psychotic features. Functioning is
impaired but not hospitalized. Best diagnosis?
A. Bipolar I Disorder, current manic episode
B. Bipolar II Disorder, hypomanic episode
C. Cyclothymic Disorder
D. Other Specified Bipolar and Related Disorder
Correct Answer: D
Rationale: DSM-5-TR requires ≥4 days for hypomania and ≥1
week for mania (unless hospitalization). A 3-day duration meets
neither; therefore "Other Specified Bipolar" fits when
symptoms are subthreshold in duration yet clinically significant.
Q3. Which set of features most strongly differentiates Bipolar I
with psychotic features from Schizoaffective Disorder, bipolar
type?
,A. Presence of hallucinations and delusions during mood
episodes only
B. A major mood episode present for majority of total illness
duration
C. Psychotic symptoms present for ≥2 weeks in the absence of
mood symptoms
D. Rapid cycling (>4 mood episodes/year)
Correct Answer: C
Rationale: Schizoaffective diagnosis requires ≥2 weeks of
psychosis without a major mood episode; if psychosis occurs
only during mood episodes, diagnosis favors mood disorder
with psychotic features (e.g., Bipolar I with psychotic features).
Q4. Select all that apply. Which findings most strongly support a
diagnosis of delirium rather than major neurocognitive disorder
(NCD)?
A. Acute onset over hours to days
B. Fluctuating level of consciousness and attention
C. Progressive decline over months with preserved attention
D. Reversible with treatment of underlying medical cause
Correct Answer: A, B, D
Rationale: Delirium is characterized by acute onset, fluctuating
attention/level of consciousness, and often reversibility when
the precipitant is treated. Progressive decline with preserved
attention is more consistent with major NCD.
, Q5. A 7-year-old displays temper outbursts that are grossly out
of proportion, occur daily, and persistent irritable mood
between outbursts for 12 months across settings. Which
diagnosis best fits?
A. Oppositional Defiant Disorder (ODD)
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Conduct Disorder
D. Bipolar Disorder, pediatric presentation
Correct Answer: B
Rationale: DMDD is defined by severe recurrent temper
outbursts, chronic persistent irritability between outbursts,
onset before age 10, and duration ≥12 months across settings.
ODD involves oppositional behavior but not the severe temper
outbursts and pervasive mood criterion.
Q6. A 68-year-old with Parkinson disease develops visual
hallucinations, cognitive fluctuations, and parkinsonism for 2
years. According to DSM-5-TR differential diagnosis, the most
appropriate diagnosis is:
A. Major Neurocognitive Disorder due to Alzheimer’s disease
B. Major Neurocognitive Disorder with Lewy bodies (DLB)
C. Parkinson's Disease with comorbid major NCD due to
Alzheimer’s
D. Delirium
