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 presents with a 3-week history of markedly
depressed mood, anhedonia, insomnia, decreased
concentration, weight loss, and psychomotor retardation after
the end of a long-term relationship. Symptoms began 2 weeks
after the breakup. The patient has no prior psychiatric history.
Which diagnosis is most appropriate?
A. Major Depressive Disorder, single episode
B. Adjustment Disorder with depressed mood
C. Persistent Depressive Disorder (Dysthymia)
D. Normal bereavement
,Correct Answer: B
Rationale: Per DSM-5-TR, the timing (onset within 3 months of
identifiable stressor) and the context (recent relationship
termination) favor Adjustment Disorder. Symptoms are less
than 6 months and are in direct response to a stressor; major
depressive disorder requires symptom criteria and duration ≥2
weeks but also exclusion for a normal bereavement/adjustment
context. Persistent Depressive Disorder requires ≥2 years
duration. Normal bereavement typically has waves of positive
memories and predominance of feelings of loss rather than
pervasive functional impairment.
Q2. A 45-year-old reports recurrent panic attacks with sweating,
palpitations, chest discomfort, fear of losing control, and
avoidance of leaving home alone for 6 months. The panic
attacks occur unexpectedly and sometimes in crowded stores.
The best diagnosis is:
A. Panic Disorder
B. Agoraphobia
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: A
Rationale: Panic Disorder is characterized by recurrent
unexpected panic attacks with at least 1 month of persistent
concern or behavioral change. Although avoidance of leaving
home alone suggests agoraphobic features, the primary
,symptom is recurrent unexpected panic attacks; agoraphobia
requires marked fear/avoidance of situations due to concern
about escape or help, but here panic attacks are central and not
exclusively situation-bound.
Q3. A 17-year-old adolescent presents with persistent
irritability, temper outbursts occurring three times weekly for
the past 18 months (since age 16), and severe functional
impairment at school and home. Which diagnosis is most
consistent?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Intermittent Explosive Disorder
D. Major Depressive Disorder
Correct Answer: A
Rationale: DMDD requires onset before age 10 and typically is
diagnosed in children up to 12; it is not appropriate for onset in
adolescence. Intermittent Explosive Disorder includes discrete
episodes of aggressive outbursts disproportionate to stressors.
Oppositional Defiant Disorder fits persistent pattern of
irritability/temper outbursts in adolescents. Major Depressive
Disorder would require mood symptoms meeting full
depressive criteria.
, Q4. A 32-year-old with a 6-year history of elevated mood
episodes lasting 4–7 days with decreased need for sleep,
increased goal-directed activity, and risky behavior that
interfere with functioning, plus periods of major depression.
Best diagnosis:
A. Bipolar I Disorder
B. Bipolar II Disorder
C. Cyclothymic Disorder
D. Major Depressive Disorder, recurrent
Correct Answer: A
Rationale: Hypomanic episodes are typically ≥4 days but do not
cause marked impairment; mania (Bipolar I) involves full manic
episodes with marked impairment. The patient's elevated
episodes are 4–7 days with risky behavior and functional
interference consistent with mania rather than hypomania;
presence of major depressive episodes and full manic
symptoms indicates Bipolar I.
Q5. Select all that apply. A 60-year-old presents with
progressive memory decline over 18 months affecting
instrumental activities of daily living, impaired orientation to
time occasionally, and executive dysfunction. Which features
support a diagnosis of Major Neurocognitive Disorder (NCD)
due to Alzheimer’s disease rather than vascular NCD? (Select all
that apply.)
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 28-year-old presents with a 3-week history of markedly
depressed mood, anhedonia, insomnia, decreased
concentration, weight loss, and psychomotor retardation after
the end of a long-term relationship. Symptoms began 2 weeks
after the breakup. The patient has no prior psychiatric history.
Which diagnosis is most appropriate?
A. Major Depressive Disorder, single episode
B. Adjustment Disorder with depressed mood
C. Persistent Depressive Disorder (Dysthymia)
D. Normal bereavement
,Correct Answer: B
Rationale: Per DSM-5-TR, the timing (onset within 3 months of
identifiable stressor) and the context (recent relationship
termination) favor Adjustment Disorder. Symptoms are less
than 6 months and are in direct response to a stressor; major
depressive disorder requires symptom criteria and duration ≥2
weeks but also exclusion for a normal bereavement/adjustment
context. Persistent Depressive Disorder requires ≥2 years
duration. Normal bereavement typically has waves of positive
memories and predominance of feelings of loss rather than
pervasive functional impairment.
Q2. A 45-year-old reports recurrent panic attacks with sweating,
palpitations, chest discomfort, fear of losing control, and
avoidance of leaving home alone for 6 months. The panic
attacks occur unexpectedly and sometimes in crowded stores.
The best diagnosis is:
A. Panic Disorder
B. Agoraphobia
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: A
Rationale: Panic Disorder is characterized by recurrent
unexpected panic attacks with at least 1 month of persistent
concern or behavioral change. Although avoidance of leaving
home alone suggests agoraphobic features, the primary
,symptom is recurrent unexpected panic attacks; agoraphobia
requires marked fear/avoidance of situations due to concern
about escape or help, but here panic attacks are central and not
exclusively situation-bound.
Q3. A 17-year-old adolescent presents with persistent
irritability, temper outbursts occurring three times weekly for
the past 18 months (since age 16), and severe functional
impairment at school and home. Which diagnosis is most
consistent?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Intermittent Explosive Disorder
D. Major Depressive Disorder
Correct Answer: A
Rationale: DMDD requires onset before age 10 and typically is
diagnosed in children up to 12; it is not appropriate for onset in
adolescence. Intermittent Explosive Disorder includes discrete
episodes of aggressive outbursts disproportionate to stressors.
Oppositional Defiant Disorder fits persistent pattern of
irritability/temper outbursts in adolescents. Major Depressive
Disorder would require mood symptoms meeting full
depressive criteria.
, Q4. A 32-year-old with a 6-year history of elevated mood
episodes lasting 4–7 days with decreased need for sleep,
increased goal-directed activity, and risky behavior that
interfere with functioning, plus periods of major depression.
Best diagnosis:
A. Bipolar I Disorder
B. Bipolar II Disorder
C. Cyclothymic Disorder
D. Major Depressive Disorder, recurrent
Correct Answer: A
Rationale: Hypomanic episodes are typically ≥4 days but do not
cause marked impairment; mania (Bipolar I) involves full manic
episodes with marked impairment. The patient's elevated
episodes are 4–7 days with risky behavior and functional
interference consistent with mania rather than hypomania;
presence of major depressive episodes and full manic
symptoms indicates Bipolar I.
Q5. Select all that apply. A 60-year-old presents with
progressive memory decline over 18 months affecting
instrumental activities of daily living, impaired orientation to
time occasionally, and executive dysfunction. Which features
support a diagnosis of Major Neurocognitive Disorder (NCD)
due to Alzheimer’s disease rather than vascular NCD? (Select all
that apply.)
