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 28-year-old woman presents with a 3-week history of
depressed mood, anhedonia, hypersomnia, increased appetite,
low energy, and excessive guilt. She reports poor concentration
and passive suicidal ideation without plan. Symptoms began 2
weeks after her husband left for a six-month deployment.
Before this episode she had no psychiatric history. Which
diagnosis best fits her presentation?
A. Major depressive disorder, single episode, moderate
B. Adjustment disorder with depressed mood
,C. Persistent depressive disorder (dysthymia)
D. Normal bereavement reaction
Correct Answer: B
Rationale: DSM-5-TR criteria for adjustment disorder include
emotional/behavioral symptoms in response to an identifiable
stressor (husband's deployment) within 3 months, causing
marked distress and functional impairment but not meeting
criteria for MDD (duration and severity typically less; here onset
closely tied to stressor and shorter than 2 weeks required for
bereavement/more persistent MDD criteria). Major depressive
disorder requires 2+ weeks of symptoms but should be
distinguished by lack of identifiable stressor precipitating
proportional distress; persistent depressive disorder requires ≥2
years. Normal bereavement often includes waves of positive
memories and preserved self-esteem which are not described.
Q2. A 55-year-old man with a 30 pack-year smoking history
presents with 6 months of low mood, fatigue, and poor
concentration. He reports early morning awakening and marked
psychomotor retardation. On exam he has 7 kg unintentional
weight loss and denies suicidal ideation. Which feature most
strongly supports a diagnosis of major depressive disorder with
melancholic features over hypothyroidism?
A. Early morning awakening and psychomotor retardation
B. Unintentional weight loss
C. Low energy and poor concentration
D. Family history of hypothyroidism
,Correct Answer: A
Rationale: Melancholic features include distinct quality of
depressed mood, early morning awakening, marked
psychomotor disturbance, significant weight loss, and excessive
guilt. While hypothyroidism can cause fatigue, weight changes,
and cognitive slowing, psychomotor retardation and diurnal
variation (worse in morning) with profound anhedonia point
toward melancholic depression. Family history of
hypothyroidism would suggest investigating thyroid function
first but is not a feature supporting melancholic depression.
Q3. (Select all that apply) A 22-year-old college student
presents with episodic palpitations, shaking, derealization, and
fear of dying. Episodes last 15–30 minutes and have occurred
unexpectedly and in social settings, causing her to avoid
presentations. Which of the following support a diagnosis of
panic disorder rather than specific phobia or social anxiety
disorder?
A. Unexpected panic attacks not limited to social situations
B. Avoidance specifically of public speaking only
C. Persistent concern about additional attacks and their
consequences
D. Panic attacks are always cued by social performance
Correct Answer: A, C
Rationale: Panic disorder is characterized by recurrent
unexpected panic attacks and at least one month of persistent
concern or worry about attacks or their consequences and/or
, maladaptive change in behavior (avoidance). Social anxiety
disorder usually involves anxiety triggered by
social/performance situations (cued), and specific phobia
involves circumscribed situations; option B suggests isolated
performance anxiety, not panic disorder. Option D is false
because panic attacks can be unexpected (uncued).
Q4. A 34-year-old male veteran reports recurrent nightmares,
intrusive memories of multiple combat events, hypervigilance,
irritability, and avoidance of reminders for 8 months. He also
endorses persistent negative beliefs about the world and
himself and feels estranged from others. What additional
symptom would, if present, most strongly support a comorbid
diagnosis of PTSD with dissociative subtype per DSM-5-TR?
A. Persistent anhedonia
B. Periodic episodes of derealization or depersonalization
during recall
C. Chronic insomnia unresponsive to meds
D. Alcohol use to reduce anxiety
Correct Answer: B
Rationale: DSM-5-TR specifies a dissociative subtype of PTSD
when persistent or recurrent symptoms of depersonalization
and/or derealization accompany PTSD. Anhedonia and insomnia
are common but not diagnostic for the dissociative subtype;
substance use may be comorbid but not specific to the subtype.
Q5. A 16-year-old adolescent presents with 3 months of low
mood, irritability, hypersomnia, increased appetite, and weight
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 28-year-old woman presents with a 3-week history of
depressed mood, anhedonia, hypersomnia, increased appetite,
low energy, and excessive guilt. She reports poor concentration
and passive suicidal ideation without plan. Symptoms began 2
weeks after her husband left for a six-month deployment.
Before this episode she had no psychiatric history. Which
diagnosis best fits her presentation?
A. Major depressive disorder, single episode, moderate
B. Adjustment disorder with depressed mood
,C. Persistent depressive disorder (dysthymia)
D. Normal bereavement reaction
Correct Answer: B
Rationale: DSM-5-TR criteria for adjustment disorder include
emotional/behavioral symptoms in response to an identifiable
stressor (husband's deployment) within 3 months, causing
marked distress and functional impairment but not meeting
criteria for MDD (duration and severity typically less; here onset
closely tied to stressor and shorter than 2 weeks required for
bereavement/more persistent MDD criteria). Major depressive
disorder requires 2+ weeks of symptoms but should be
distinguished by lack of identifiable stressor precipitating
proportional distress; persistent depressive disorder requires ≥2
years. Normal bereavement often includes waves of positive
memories and preserved self-esteem which are not described.
Q2. A 55-year-old man with a 30 pack-year smoking history
presents with 6 months of low mood, fatigue, and poor
concentration. He reports early morning awakening and marked
psychomotor retardation. On exam he has 7 kg unintentional
weight loss and denies suicidal ideation. Which feature most
strongly supports a diagnosis of major depressive disorder with
melancholic features over hypothyroidism?
A. Early morning awakening and psychomotor retardation
B. Unintentional weight loss
C. Low energy and poor concentration
D. Family history of hypothyroidism
,Correct Answer: A
Rationale: Melancholic features include distinct quality of
depressed mood, early morning awakening, marked
psychomotor disturbance, significant weight loss, and excessive
guilt. While hypothyroidism can cause fatigue, weight changes,
and cognitive slowing, psychomotor retardation and diurnal
variation (worse in morning) with profound anhedonia point
toward melancholic depression. Family history of
hypothyroidism would suggest investigating thyroid function
first but is not a feature supporting melancholic depression.
Q3. (Select all that apply) A 22-year-old college student
presents with episodic palpitations, shaking, derealization, and
fear of dying. Episodes last 15–30 minutes and have occurred
unexpectedly and in social settings, causing her to avoid
presentations. Which of the following support a diagnosis of
panic disorder rather than specific phobia or social anxiety
disorder?
A. Unexpected panic attacks not limited to social situations
B. Avoidance specifically of public speaking only
C. Persistent concern about additional attacks and their
consequences
D. Panic attacks are always cued by social performance
Correct Answer: A, C
Rationale: Panic disorder is characterized by recurrent
unexpected panic attacks and at least one month of persistent
concern or worry about attacks or their consequences and/or
, maladaptive change in behavior (avoidance). Social anxiety
disorder usually involves anxiety triggered by
social/performance situations (cued), and specific phobia
involves circumscribed situations; option B suggests isolated
performance anxiety, not panic disorder. Option D is false
because panic attacks can be unexpected (uncued).
Q4. A 34-year-old male veteran reports recurrent nightmares,
intrusive memories of multiple combat events, hypervigilance,
irritability, and avoidance of reminders for 8 months. He also
endorses persistent negative beliefs about the world and
himself and feels estranged from others. What additional
symptom would, if present, most strongly support a comorbid
diagnosis of PTSD with dissociative subtype per DSM-5-TR?
A. Persistent anhedonia
B. Periodic episodes of derealization or depersonalization
during recall
C. Chronic insomnia unresponsive to meds
D. Alcohol use to reduce anxiety
Correct Answer: B
Rationale: DSM-5-TR specifies a dissociative subtype of PTSD
when persistent or recurrent symptoms of depersonalization
and/or derealization accompany PTSD. Anhedonia and insomnia
are common but not diagnostic for the dissociative subtype;
substance use may be comorbid but not specific to the subtype.
Q5. A 16-year-old adolescent presents with 3 months of low
mood, irritability, hypersomnia, increased appetite, and weight
