NR 547 Final Exam 2025/2026 Chamberlain
PMHNP Test Bank | Differential Diagnosis in
Psychiatric–Mental Health Across the Lifespan |
50 Graduate-Level Questions & Answers
Q1. A 34-year-old teacher reports 6 months of low mood,
anergia, hypersomnia, increased appetite with 10-pound weight
gain, and feelings of hopelessness. She denies manic or
hypomanic episodes. Symptoms began gradually after a
relationship breakup and cause moderate impairment at work.
Which diagnosis best fits?
A. Major Depressive Disorder (single episode), moderate
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with depressed mood
D. Major Depressive Disorder, recurrent, mild
Correct Answer: B
Rationale: Duration (≥2 years for adults) is required for
Persistent Depressive Disorder per DSM-5-TR; however, the
vignette states 6 months—this is a trick: the correct differential
,is Adjustment Disorder if <2 years and onset after stressor with
functional impairment. Given 6 months duration and clear
psychosocial stressor, C would be plausible; but the stem asks
"best fits" and symptoms are syndromal with marked
appetite/weight and hypersomnia—these point to Major
Depressive Episode but timeframe (6 months) meets MDD
duration (≥2 weeks). However recurrent vs single episode
cannot be determined. The most precise differential: A. Major
Depressive Disorder (single episode), moderate.
(Note: examinees must prioritize DSM-5-TR episodic criteria and
absence of 2-year chronicity for dysthymia.)
Q2. A 28-year-old with a history of two weeks of elevated
mood, decreased need for sleep (2–3 hours nightly), pressured
speech, increased goal-directed activity, risky sexual behavior,
and impaired judgment lasting 10 days. No psychotic features.
Most likely diagnosis?
A. Hypomanic episode
B. Manic episode, severe without psychotic features
C. Manic episode, moderate with impaired functioning
D. Cyclothymic disorder
Correct Answer: B
Rationale: DSM-5-TR defines a manic episode as lasting ≥1 week
with marked impairment; this vignette shows significant
impairment (risky behavior, impaired judgment) and duration of
10 days, consistent with mania. Hypomania lacks marked
impairment and does not cause significant social/occupational
,dysfunction. Cyclothymia requires ≥2 years fluctuating
subthreshold hypomanic/depressive symptoms.
Q3. A 45-year-old presents with sudden onset of intense fear,
palpitations, derealization, and urge to escape while shopping;
these episodes are unpredictable and peak within 10 minutes.
He now avoids stores for fear of another episode. Best
diagnosis?
A. Panic disorder
B. Specific phobia, situational type
C. Agoraphobia
D. Social anxiety disorder
Correct Answer: A
Rationale: Panic disorder features recurrent unexpected panic
attacks plus at least one month of worry about further attacks
or maladaptive change. Avoidance of situations due to fear of
panic can coexist, but the core is recurrent unexpected panic
attacks—differentiating from specific phobia (anticipated, cued)
and agoraphobia (fear/avoidance of situations where escape is
difficult), though agoraphobia may develop secondarily.
Q4. A 70-year-old with fluctuating attention, visual
hallucinations, and onset of confusion over 48 hours after
urinary tract infection. Which is most likely?
A. Major neurocognitive disorder (dementia)
B. Delirium
, C. Schizoaffective disorder
D. Lewy body dementia
Correct Answer: B
Rationale: Acute onset (hours–days), fluctuating
consciousness/attention, and precipitating medical cause are
hallmark of delirium per DSM-5-TR. Major neurocognitive
disorders develop insidiously over months/years. Lewy body
dementia may present with visual hallucinations but has
chronic course.
Q5. A 16-year-old with persistent irritability, temper outbursts
(≥3 times/week), and mood between outbursts described as
angry for 14 months across settings. Most appropriate
diagnosis?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Intermittent Explosive Disorder
D. Conduct Disorder
Correct Answer: B
Rationale: DMDD (DSM-5-TR) requires severe recurrent temper
outbursts and persistent irritable/angry mood for ≥12 months,
onset before age 10 and diagnosis by 6–18 years; differs from
ODD by chronicity and severity and from IED by nature of
outbursts (impulsive aggressive acts).
Q6. A 30-year-old reports intrusive memories, hypervigilance,
avoidance of reminders, negative alterations in cognition and
PMHNP Test Bank | Differential Diagnosis in
Psychiatric–Mental Health Across the Lifespan |
50 Graduate-Level Questions & Answers
Q1. A 34-year-old teacher reports 6 months of low mood,
anergia, hypersomnia, increased appetite with 10-pound weight
gain, and feelings of hopelessness. She denies manic or
hypomanic episodes. Symptoms began gradually after a
relationship breakup and cause moderate impairment at work.
Which diagnosis best fits?
A. Major Depressive Disorder (single episode), moderate
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with depressed mood
D. Major Depressive Disorder, recurrent, mild
Correct Answer: B
Rationale: Duration (≥2 years for adults) is required for
Persistent Depressive Disorder per DSM-5-TR; however, the
vignette states 6 months—this is a trick: the correct differential
,is Adjustment Disorder if <2 years and onset after stressor with
functional impairment. Given 6 months duration and clear
psychosocial stressor, C would be plausible; but the stem asks
"best fits" and symptoms are syndromal with marked
appetite/weight and hypersomnia—these point to Major
Depressive Episode but timeframe (6 months) meets MDD
duration (≥2 weeks). However recurrent vs single episode
cannot be determined. The most precise differential: A. Major
Depressive Disorder (single episode), moderate.
(Note: examinees must prioritize DSM-5-TR episodic criteria and
absence of 2-year chronicity for dysthymia.)
Q2. A 28-year-old with a history of two weeks of elevated
mood, decreased need for sleep (2–3 hours nightly), pressured
speech, increased goal-directed activity, risky sexual behavior,
and impaired judgment lasting 10 days. No psychotic features.
Most likely diagnosis?
A. Hypomanic episode
B. Manic episode, severe without psychotic features
C. Manic episode, moderate with impaired functioning
D. Cyclothymic disorder
Correct Answer: B
Rationale: DSM-5-TR defines a manic episode as lasting ≥1 week
with marked impairment; this vignette shows significant
impairment (risky behavior, impaired judgment) and duration of
10 days, consistent with mania. Hypomania lacks marked
impairment and does not cause significant social/occupational
,dysfunction. Cyclothymia requires ≥2 years fluctuating
subthreshold hypomanic/depressive symptoms.
Q3. A 45-year-old presents with sudden onset of intense fear,
palpitations, derealization, and urge to escape while shopping;
these episodes are unpredictable and peak within 10 minutes.
He now avoids stores for fear of another episode. Best
diagnosis?
A. Panic disorder
B. Specific phobia, situational type
C. Agoraphobia
D. Social anxiety disorder
Correct Answer: A
Rationale: Panic disorder features recurrent unexpected panic
attacks plus at least one month of worry about further attacks
or maladaptive change. Avoidance of situations due to fear of
panic can coexist, but the core is recurrent unexpected panic
attacks—differentiating from specific phobia (anticipated, cued)
and agoraphobia (fear/avoidance of situations where escape is
difficult), though agoraphobia may develop secondarily.
Q4. A 70-year-old with fluctuating attention, visual
hallucinations, and onset of confusion over 48 hours after
urinary tract infection. Which is most likely?
A. Major neurocognitive disorder (dementia)
B. Delirium
, C. Schizoaffective disorder
D. Lewy body dementia
Correct Answer: B
Rationale: Acute onset (hours–days), fluctuating
consciousness/attention, and precipitating medical cause are
hallmark of delirium per DSM-5-TR. Major neurocognitive
disorders develop insidiously over months/years. Lewy body
dementia may present with visual hallucinations but has
chronic course.
Q5. A 16-year-old with persistent irritability, temper outbursts
(≥3 times/week), and mood between outbursts described as
angry for 14 months across settings. Most appropriate
diagnosis?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Intermittent Explosive Disorder
D. Conduct Disorder
Correct Answer: B
Rationale: DMDD (DSM-5-TR) requires severe recurrent temper
outbursts and persistent irritable/angry mood for ≥12 months,
onset before age 10 and diagnosis by 6–18 years; differs from
ODD by chronicity and severity and from IED by nature of
outbursts (impulsive aggressive acts).
Q6. A 30-year-old reports intrusive memories, hypervigilance,
avoidance of reminders, negative alterations in cognition and
