NR 547 Final Exam 2025/2026 Test Bank |
Differential Diagnosis in Psychiatric–Mental
Health Across the Lifespan | Chamberlain
PMHNP | 50 Graduate-Level Questions &
Answers
Q1. A 28-year-old presents with a 3-week history of depressed
mood, anergia, hypersomnia, increased appetite with 6-pound
weight gain, and worthlessness. He reports passive suicidal
ideation without plan. There is no history of manic or
hypomanic episodes. Which diagnosis best fits DSM-5-TR
criteria?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (dysthymia)
C. Bipolar II disorder, current depressed episode
D. Adjustment disorder with depressed mood
Correct Answer: A
Rationale: Symptoms meet DSM-5-TR criteria for a major
depressive episode (≥2 weeks, depressed mood, sleep/appetite
changes, feelings of worthlessness, suicidal ideation). No prior
,hypomania/mania rules out bipolar disorders. Duration (3
weeks) is too short and severity greater than adjustment
disorder (which requires identifiable stressor and subthreshold
MDD criteria). Dysthymia requires ≥2 years.
Q2. A 45-year-old with a history of alcohol use disorder
presents with tremor, anxiety, insomnia, nausea, and visual
hallucinations beginning 48 hours after last drink. What is the
most likely diagnosis?
A. Primary psychotic disorder (schizophrenia)
B. Alcohol withdrawal with perceptual disturbances
C. Delirium due to medical condition
D. Major depressive disorder with psychotic features
Correct Answer: B
Rationale: Onset within 6–48 hours after cessation and
presence of autonomic hyperactivity, tremor, and perceptual
disturbances fit DSM-5-TR criteria for alcohol withdrawal.
Delirium could overlap but timing and clear withdrawal context
make withdrawal most likely. Primary psychotic disorder lacks
temporal relation to substance cessation.
Q3. A 19-year-old college student reports persistent worry
about multiple domains for 18 months, difficulty concentrating,
restlessness, muscle tension, and impaired sleep. Symptoms
began before college and cause impairment. What
,differentiates Generalized Anxiety Disorder (GAD) from normal
worry and adjustment disorder?
A. Duration ≥6 months and number of domains
B. Presence of a specific stressor immediately preceding onset
C. Psychotic features accompanying worry
D. Worry responsive to reassurance only
Correct Answer: A
Rationale: DSM-5-TR requires excessive anxiety/worry more
days than not for ≥6 months about multiple events with
associated symptoms. Adjustment disorder typically follows
identifiable stressor and is of shorter duration; normal worry is
not pervasive or functionally impairing. Psychotic features are
not characteristic of GAD.
Q4. A 32-year-old veteran reports nightmares, intrusive
memories, hypervigilance, avoidance of reminders, and
negative alterations in mood lasting 10 days after a combat
event. Which diagnosis is most consistent with DSM-5-TR?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment disorder with disturbance of conduct
D. Generalized Anxiety Disorder
Correct Answer: A
Rationale: Acute Stress Disorder applies when trauma-related
symptoms occur within 3 days to 1 month after the traumatic
, event. PTSD requires persistence beyond 1 month. The
symptom cluster (intrusion, avoidance, negative mood,
hyperarousal) matches acute stress disorder given 10-day
course.
Q5. A 62-year-old presents with new-onset confusion
fluctuating over hours, inattention, and visual hallucinations. He
is febrile and has urinary retention. Which diagnosis is most
likely?
A. Major neurocognitive disorder (dementia)
B. Delirium due to a medical condition
C. Schizoaffective disorder
D. Brief psychotic disorder
Correct Answer: B
Rationale: Acute onset with fluctuating consciousness,
inattention, and perceptual disturbances in the context of
medical illness (fever, urinary retention) meet DSM-5-TR
delirium criteria. Dementia is gradual and persistent; brief
psychotic disorder lacks prominent disturbance in
attention/awareness and a medical trigger.
Q6. A 25-year-old woman has periods of elevated mood,
decreased need for sleep, increased goal-directed activity for 5
days, and marked impairment requiring hospitalization during
Differential Diagnosis in Psychiatric–Mental
Health Across the Lifespan | Chamberlain
PMHNP | 50 Graduate-Level Questions &
Answers
Q1. A 28-year-old presents with a 3-week history of depressed
mood, anergia, hypersomnia, increased appetite with 6-pound
weight gain, and worthlessness. He reports passive suicidal
ideation without plan. There is no history of manic or
hypomanic episodes. Which diagnosis best fits DSM-5-TR
criteria?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (dysthymia)
C. Bipolar II disorder, current depressed episode
D. Adjustment disorder with depressed mood
Correct Answer: A
Rationale: Symptoms meet DSM-5-TR criteria for a major
depressive episode (≥2 weeks, depressed mood, sleep/appetite
changes, feelings of worthlessness, suicidal ideation). No prior
,hypomania/mania rules out bipolar disorders. Duration (3
weeks) is too short and severity greater than adjustment
disorder (which requires identifiable stressor and subthreshold
MDD criteria). Dysthymia requires ≥2 years.
Q2. A 45-year-old with a history of alcohol use disorder
presents with tremor, anxiety, insomnia, nausea, and visual
hallucinations beginning 48 hours after last drink. What is the
most likely diagnosis?
A. Primary psychotic disorder (schizophrenia)
B. Alcohol withdrawal with perceptual disturbances
C. Delirium due to medical condition
D. Major depressive disorder with psychotic features
Correct Answer: B
Rationale: Onset within 6–48 hours after cessation and
presence of autonomic hyperactivity, tremor, and perceptual
disturbances fit DSM-5-TR criteria for alcohol withdrawal.
Delirium could overlap but timing and clear withdrawal context
make withdrawal most likely. Primary psychotic disorder lacks
temporal relation to substance cessation.
Q3. A 19-year-old college student reports persistent worry
about multiple domains for 18 months, difficulty concentrating,
restlessness, muscle tension, and impaired sleep. Symptoms
began before college and cause impairment. What
,differentiates Generalized Anxiety Disorder (GAD) from normal
worry and adjustment disorder?
A. Duration ≥6 months and number of domains
B. Presence of a specific stressor immediately preceding onset
C. Psychotic features accompanying worry
D. Worry responsive to reassurance only
Correct Answer: A
Rationale: DSM-5-TR requires excessive anxiety/worry more
days than not for ≥6 months about multiple events with
associated symptoms. Adjustment disorder typically follows
identifiable stressor and is of shorter duration; normal worry is
not pervasive or functionally impairing. Psychotic features are
not characteristic of GAD.
Q4. A 32-year-old veteran reports nightmares, intrusive
memories, hypervigilance, avoidance of reminders, and
negative alterations in mood lasting 10 days after a combat
event. Which diagnosis is most consistent with DSM-5-TR?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment disorder with disturbance of conduct
D. Generalized Anxiety Disorder
Correct Answer: A
Rationale: Acute Stress Disorder applies when trauma-related
symptoms occur within 3 days to 1 month after the traumatic
, event. PTSD requires persistence beyond 1 month. The
symptom cluster (intrusion, avoidance, negative mood,
hyperarousal) matches acute stress disorder given 10-day
course.
Q5. A 62-year-old presents with new-onset confusion
fluctuating over hours, inattention, and visual hallucinations. He
is febrile and has urinary retention. Which diagnosis is most
likely?
A. Major neurocognitive disorder (dementia)
B. Delirium due to a medical condition
C. Schizoaffective disorder
D. Brief psychotic disorder
Correct Answer: B
Rationale: Acute onset with fluctuating consciousness,
inattention, and perceptual disturbances in the context of
medical illness (fever, urinary retention) meet DSM-5-TR
delirium criteria. Dementia is gradual and persistent; brief
psychotic disorder lacks prominent disturbance in
attention/awareness and a medical trigger.
Q6. A 25-year-old woman has periods of elevated mood,
decreased need for sleep, increased goal-directed activity for 5
days, and marked impairment requiring hospitalization during
