NR 547 Final Exam Guide 2025/2026 |
Chamberlain College of Nursing | PMHNP
Differential Diagnosis Practicum | 50 Expert
Q&A with Rationales [Official 2025/2026
Edition]
Q1. A 24-year-old graduate student presents with a 10-month
history of persistent, pervasive low mood, anhedonia, and
profound fatigue. He reports sleeping 12 hours daily yet never
feeling rested, a 15-pound weight gain, and a constant feeling of
being "leaden" or paralyzed. He denies distinct mood reactivity
or rejection sensitivity. His academic functioning has
significantly declined. What is the most likely specifier for his
Major Depressive Disorder?
A. With atypical features
B. With melancholic features
C. With catatonic features
D. With seasonal pattern
Correct Answer: B
Rationale: While hypersomnia and weight gain are often
associated with atypical features, the DSM-5-TR criteria
for Melancholic Features include distinct quality of depressed
mood (profound despondency), lack of mood reactivity, and at
least three of: morning worsening, early morning awakening,
,marked psychomotor agitation/retardation, significant
anorexia/weight loss, excessive guilt, and worse mood in the
morning. The "leaden paralysis" and non-restorative sleep align
more closely with melancholia. Atypical features require mood
reactivity and at least two of: significant weight gain/appetite
increase, hypersomnia, leaden paralysis, and long-standing
pattern of interpersonal rejection sensitivity.
Q2. A 7-year-old boy is brought in by his parents due to
frequent "tantrums" that are severe, prolonged, and out of
proportion to the trigger. These occur 4-5 times per week.
Between episodes, his mood is persistently irritable and angry
most of the day, nearly every day, noticeable by teachers and
peers. This pattern has been present for over 14 months. What
is the most appropriate diagnosis?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder, Combined
Presentation
C. Disruptive Mood Dysregulation Disorder
D. Pediatric Bipolar I Disorder
Correct Answer: C
Rationale: Disruptive Mood Dysregulation Disorder (DMDD) is
characterized by severe recurrent temper
outbursts (verbal/behavioral) grossly out of proportion to the
situation, occurring three or more times per week, and a
persistently irritable or angry mood between outbursts, present
for 12+ months. The key differentiator from Oppositional
,Defiant Disorder (ODD) is the severity and frequency of the
outbursts and the persistent between-episode irritability.
DMDD was created to address over-diagnosis of pediatric
bipolar disorder; mania/hypomania episodes are not present.
Q3. A 58-year-old woman with a history of Generalized Anxiety
Disorder presents with a 4-month history of worsening anxiety,
low mood, insomnia, and an intense, persistent fear that she
has pancreatic cancer despite three separate negative workups
(CT, MRI, endoscopic ultrasound) by a gastroenterologist. She
spends hours daily researching symptoms online and has
missed significant work for medical appointments. What is the
primary diagnosis?
A. Illness Anxiety Disorder
B. Somatic Symptom Disorder
C. Generalized Anxiety Disorder
D. Major Depressive Disorder with anxious distress
Correct Answer: A
Rationale: Illness Anxiety Disorder is preoccupation with having
or acquiring a serious illness. Somatic symptoms are not
present or, if present, are only mild in intensity. The
preoccupation persists despite appropriate medical evaluation
and reassurance. This contrasts with Somatic Symptom
Disorder, which involves distressing somatic
symptoms accompanied by excessive thoughts, feelings, or
behaviors related to those symptoms. Her anxiety is channeled
specifically into health concerns, not the broad worry of GAD.
, Q4. A 35-year-old man is brought to the ED by police after being
found walking in traffic, stating he was "following the hidden
messages." On exam, he is disheveled, makes poor eye contact,
and displays tangential thought process. He reports auditory
hallucinations commenting on his actions and delusions of
reference about the TV. His family states he has been
increasingly withdrawn and dysfunctional over the past 18
months, with a clear decline from his previous level of
functioning. What is the most accurate diagnosis?
A. Schizophreniform Disorder
B. Delusional Disorder
C. Schizoaffective Disorder
D. Schizophrenia
Correct Answer: D
Rationale: A diagnosis of Schizophrenia requires two or more
active phase symptoms (delusions, hallucinations, disorganized
speech, grossly disorganized/catatonic behavior, negative
symptoms) for a significant portion of time during a 1-month
period, with continuous signs of disturbance persisting for at
least 6 months. This 18-month timeline with progressive
decline and a 1-month period of acute positive symptoms
meets criteria. Schizophreniform Disorder requires symptoms
identical to schizophrenia but lasting less than 6 months.
Q5. (Select All That Apply) A 42-year-old female with Borderline
Personality Disorder is being evaluated for comorbid mood
disorder. Which of the following clinical features would be more
Chamberlain College of Nursing | PMHNP
Differential Diagnosis Practicum | 50 Expert
Q&A with Rationales [Official 2025/2026
Edition]
Q1. A 24-year-old graduate student presents with a 10-month
history of persistent, pervasive low mood, anhedonia, and
profound fatigue. He reports sleeping 12 hours daily yet never
feeling rested, a 15-pound weight gain, and a constant feeling of
being "leaden" or paralyzed. He denies distinct mood reactivity
or rejection sensitivity. His academic functioning has
significantly declined. What is the most likely specifier for his
Major Depressive Disorder?
A. With atypical features
B. With melancholic features
C. With catatonic features
D. With seasonal pattern
Correct Answer: B
Rationale: While hypersomnia and weight gain are often
associated with atypical features, the DSM-5-TR criteria
for Melancholic Features include distinct quality of depressed
mood (profound despondency), lack of mood reactivity, and at
least three of: morning worsening, early morning awakening,
,marked psychomotor agitation/retardation, significant
anorexia/weight loss, excessive guilt, and worse mood in the
morning. The "leaden paralysis" and non-restorative sleep align
more closely with melancholia. Atypical features require mood
reactivity and at least two of: significant weight gain/appetite
increase, hypersomnia, leaden paralysis, and long-standing
pattern of interpersonal rejection sensitivity.
Q2. A 7-year-old boy is brought in by his parents due to
frequent "tantrums" that are severe, prolonged, and out of
proportion to the trigger. These occur 4-5 times per week.
Between episodes, his mood is persistently irritable and angry
most of the day, nearly every day, noticeable by teachers and
peers. This pattern has been present for over 14 months. What
is the most appropriate diagnosis?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder, Combined
Presentation
C. Disruptive Mood Dysregulation Disorder
D. Pediatric Bipolar I Disorder
Correct Answer: C
Rationale: Disruptive Mood Dysregulation Disorder (DMDD) is
characterized by severe recurrent temper
outbursts (verbal/behavioral) grossly out of proportion to the
situation, occurring three or more times per week, and a
persistently irritable or angry mood between outbursts, present
for 12+ months. The key differentiator from Oppositional
,Defiant Disorder (ODD) is the severity and frequency of the
outbursts and the persistent between-episode irritability.
DMDD was created to address over-diagnosis of pediatric
bipolar disorder; mania/hypomania episodes are not present.
Q3. A 58-year-old woman with a history of Generalized Anxiety
Disorder presents with a 4-month history of worsening anxiety,
low mood, insomnia, and an intense, persistent fear that she
has pancreatic cancer despite three separate negative workups
(CT, MRI, endoscopic ultrasound) by a gastroenterologist. She
spends hours daily researching symptoms online and has
missed significant work for medical appointments. What is the
primary diagnosis?
A. Illness Anxiety Disorder
B. Somatic Symptom Disorder
C. Generalized Anxiety Disorder
D. Major Depressive Disorder with anxious distress
Correct Answer: A
Rationale: Illness Anxiety Disorder is preoccupation with having
or acquiring a serious illness. Somatic symptoms are not
present or, if present, are only mild in intensity. The
preoccupation persists despite appropriate medical evaluation
and reassurance. This contrasts with Somatic Symptom
Disorder, which involves distressing somatic
symptoms accompanied by excessive thoughts, feelings, or
behaviors related to those symptoms. Her anxiety is channeled
specifically into health concerns, not the broad worry of GAD.
, Q4. A 35-year-old man is brought to the ED by police after being
found walking in traffic, stating he was "following the hidden
messages." On exam, he is disheveled, makes poor eye contact,
and displays tangential thought process. He reports auditory
hallucinations commenting on his actions and delusions of
reference about the TV. His family states he has been
increasingly withdrawn and dysfunctional over the past 18
months, with a clear decline from his previous level of
functioning. What is the most accurate diagnosis?
A. Schizophreniform Disorder
B. Delusional Disorder
C. Schizoaffective Disorder
D. Schizophrenia
Correct Answer: D
Rationale: A diagnosis of Schizophrenia requires two or more
active phase symptoms (delusions, hallucinations, disorganized
speech, grossly disorganized/catatonic behavior, negative
symptoms) for a significant portion of time during a 1-month
period, with continuous signs of disturbance persisting for at
least 6 months. This 18-month timeline with progressive
decline and a 1-month period of acute positive symptoms
meets criteria. Schizophreniform Disorder requires symptoms
identical to schizophrenia but lasting less than 6 months.
Q5. (Select All That Apply) A 42-year-old female with Borderline
Personality Disorder is being evaluated for comorbid mood
disorder. Which of the following clinical features would be more
