NR 547 Final Exam 2025/2026 Test Bank |
Chamberlain PMHNP Differential Diagnosis in
Psychiatric–Mental Health Across the Lifespan
| 50 Expert Q&A | Latest Prep Guide
Q1. A 24-year-old female presents with a 3-week history of
pervasive low mood, anhedonia, poor concentration, and
passive suicidal ideation. She reports sleeping 12 hours daily,
profound fatigue, and a 15-pound weight gain from
carbohydrate cravings. Her symptoms have a distinct seasonal
pattern for the past three winters, with full remission each
spring. What is the most accurate initial diagnosis?
A. Major Depressive Disorder, recurrent, severe
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder, with seasonal pattern
D. Bipolar II Disorder, current episode depressed, with seasonal
pattern
,Correct Answer: C
Rationale: While the core symptoms meet criteria for a Major
Depressive Episode, the key diagnostic feature is the clear
temporal relationship to a specific time of year (winter) and full
remission at a characteristic time (spring). This defines the
"with seasonal pattern" specifier for Major Depressive Disorder.
Bipolar II requires a history of at least one hypomanic episode,
which is not indicated here. The episodic nature rules out
Persistent Depressive Disorder.
Q2. A 70-year-old man with hypertension and hyperlipidemia is
brought by his daughter for increasing "confusion" over 8
months. He has gotten lost driving to familiar places, repeats
questions constantly, and has trouble managing his
medications. His neurologic exam is non-focal, but cognitive
testing shows significant deficits in short-term recall,
visuospatial ability, and executive function. These deficits
represent a clear decline from his baseline and interfere with
daily activities. Brain MRI shows generalized cortical atrophy
and hippocampal volume loss. What is the most likely
neurocognitive disorder?
A. Vascular Neurocognitive Disorder
B. Alzheimer’s Disease
C. Major Neurocognitive Disorder Due to Alzheimer’s Disease
D. Delirium
Correct Answer: C
Rationale: The presentation with insidious onset and
,progressive decline in memory and other cognitive domains,
with MRI findings consistent with Alzheimer’s pathology, points
to this diagnosis. The DSM-5-TR terminology is "Major
Neurocognitive Disorder Due to Alzheimer’s Disease."
"Alzheimer’s Disease" alone (Option B) is not the precise DSM
diagnostic label. Vascular NCD typically shows a stepwise
decline and/or focal neurological signs and imaging evidence of
cerebrovascular disease, which are not highlighted here.
Q3. A 16-year-old adolescent is referred for academic decline
and social withdrawal. Parents note he spends all his time in his
room on the computer, has no real-world friends, and displays
odd, repetitive hand movements when anxious. He has an
intense, encyclopedic knowledge of subway systems. His speech
is monotone, and he avoids eye contact. These traits have been
present since early childhood. His most likely diagnosis is:
A. Social Anxiety Disorder
B. Schizoid Personality Disorder
C. Autism Spectrum Disorder
D. Schizophrenia, prodromal phase
Correct Answer: C
Rationale: The history describes core symptoms of Autism
Spectrum Disorder: persistent deficits in social communication
and interaction (no friends, monotone speech, poor eye
contact), and restricted, repetitive patterns of behavior (odd
hand movements, intense fixated interest). These symptoms
must be present in the early developmental period. Social
, Anxiety Disorder involves fear of negative evaluation, not
fundamental social communication deficits. Schizoid PD
involves detachment from social relationships but not the
stereotyped behaviors or communication deficits. Schizophrenia
prodrome would not have stable symptoms dating back to early
childhood.
Q4. A 45-year-old female presents with a 2-year history of
widespread pain, fatigue, non-restorative sleep, and "brain fog."
Extensive medical workups by rheumatology and neurology
have been negative. She is preoccupied with having a serious
undiagnosed illness and spends hours daily researching
symptoms. Physical exam is unremarkable. The PMHNP
suspects a somatic symptom disorder. The symptom pattern
that best differentiates this condition from Illness Anxiety
Disorder is:
A. The presence of high health anxiety.
B. The chronicity of symptoms (>6 months).
C. The presence of distressing somatic symptoms.
D. The performance of excessive health-related behaviors.
Correct Answer: C
Rationale: The defining feature of Somatic Symptom Disorder is
the presence of one or more distressing somatic symptoms that
cause significant disruption in daily life. Illness Anxiety Disorder
is primarily characterized by preoccupation with having or
acquiring a serious illness, in the absence of prominent somatic
symptoms (or if a medical condition is present, the anxiety is
Chamberlain PMHNP Differential Diagnosis in
Psychiatric–Mental Health Across the Lifespan
| 50 Expert Q&A | Latest Prep Guide
Q1. A 24-year-old female presents with a 3-week history of
pervasive low mood, anhedonia, poor concentration, and
passive suicidal ideation. She reports sleeping 12 hours daily,
profound fatigue, and a 15-pound weight gain from
carbohydrate cravings. Her symptoms have a distinct seasonal
pattern for the past three winters, with full remission each
spring. What is the most accurate initial diagnosis?
A. Major Depressive Disorder, recurrent, severe
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder, with seasonal pattern
D. Bipolar II Disorder, current episode depressed, with seasonal
pattern
,Correct Answer: C
Rationale: While the core symptoms meet criteria for a Major
Depressive Episode, the key diagnostic feature is the clear
temporal relationship to a specific time of year (winter) and full
remission at a characteristic time (spring). This defines the
"with seasonal pattern" specifier for Major Depressive Disorder.
Bipolar II requires a history of at least one hypomanic episode,
which is not indicated here. The episodic nature rules out
Persistent Depressive Disorder.
Q2. A 70-year-old man with hypertension and hyperlipidemia is
brought by his daughter for increasing "confusion" over 8
months. He has gotten lost driving to familiar places, repeats
questions constantly, and has trouble managing his
medications. His neurologic exam is non-focal, but cognitive
testing shows significant deficits in short-term recall,
visuospatial ability, and executive function. These deficits
represent a clear decline from his baseline and interfere with
daily activities. Brain MRI shows generalized cortical atrophy
and hippocampal volume loss. What is the most likely
neurocognitive disorder?
A. Vascular Neurocognitive Disorder
B. Alzheimer’s Disease
C. Major Neurocognitive Disorder Due to Alzheimer’s Disease
D. Delirium
Correct Answer: C
Rationale: The presentation with insidious onset and
,progressive decline in memory and other cognitive domains,
with MRI findings consistent with Alzheimer’s pathology, points
to this diagnosis. The DSM-5-TR terminology is "Major
Neurocognitive Disorder Due to Alzheimer’s Disease."
"Alzheimer’s Disease" alone (Option B) is not the precise DSM
diagnostic label. Vascular NCD typically shows a stepwise
decline and/or focal neurological signs and imaging evidence of
cerebrovascular disease, which are not highlighted here.
Q3. A 16-year-old adolescent is referred for academic decline
and social withdrawal. Parents note he spends all his time in his
room on the computer, has no real-world friends, and displays
odd, repetitive hand movements when anxious. He has an
intense, encyclopedic knowledge of subway systems. His speech
is monotone, and he avoids eye contact. These traits have been
present since early childhood. His most likely diagnosis is:
A. Social Anxiety Disorder
B. Schizoid Personality Disorder
C. Autism Spectrum Disorder
D. Schizophrenia, prodromal phase
Correct Answer: C
Rationale: The history describes core symptoms of Autism
Spectrum Disorder: persistent deficits in social communication
and interaction (no friends, monotone speech, poor eye
contact), and restricted, repetitive patterns of behavior (odd
hand movements, intense fixated interest). These symptoms
must be present in the early developmental period. Social
, Anxiety Disorder involves fear of negative evaluation, not
fundamental social communication deficits. Schizoid PD
involves detachment from social relationships but not the
stereotyped behaviors or communication deficits. Schizophrenia
prodrome would not have stable symptoms dating back to early
childhood.
Q4. A 45-year-old female presents with a 2-year history of
widespread pain, fatigue, non-restorative sleep, and "brain fog."
Extensive medical workups by rheumatology and neurology
have been negative. She is preoccupied with having a serious
undiagnosed illness and spends hours daily researching
symptoms. Physical exam is unremarkable. The PMHNP
suspects a somatic symptom disorder. The symptom pattern
that best differentiates this condition from Illness Anxiety
Disorder is:
A. The presence of high health anxiety.
B. The chronicity of symptoms (>6 months).
C. The presence of distressing somatic symptoms.
D. The performance of excessive health-related behaviors.
Correct Answer: C
Rationale: The defining feature of Somatic Symptom Disorder is
the presence of one or more distressing somatic symptoms that
cause significant disruption in daily life. Illness Anxiety Disorder
is primarily characterized by preoccupation with having or
acquiring a serious illness, in the absence of prominent somatic
symptoms (or if a medical condition is present, the anxiety is
