NR 547 Final Exam 2025/2026 | Chamberlain
College of Nursing | Differential Diagnosis in
Psychiatric-Mental Health Practicum | 50-Q&A
Test Bank & Rationales
Q1. A 24-year-old graduate student presents with a 6-month
history of pervasive low mood, anhedonia, significant weight
gain, hypersomnia (sleeping 12+ hours daily), and a heavy,
leaden feeling in her limbs. She reports these symptoms are
consistently worse in the winter months and improve each
spring. Her PHQ-9 score is 18. She has no history of mania. The
most accurate diagnosis is:
A. Major Depressive Disorder, recurrent
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Major Depressive Disorder with Seasonal Pattern
Correct Answer: D
Rationale: While MDD recurrent is plausible, the key
discriminating feature is the clear, recurring temporal
relationship to seasons (winter worsening, spring improvement)
which meets criteria for the "with seasonal pattern" specifier.
The "atypical" features (weight gain, hypersomnia, leaden
paralysis) are commonly associated with seasonal depression.
,There is no indication of hypomania to suggest Bipolar II, and
the episode duration and severity are more acute than
Persistent Depressive Disorder.
Q2. (Select All That Apply) A 68-year-old man with a history of
Parkinson's disease is brought in by his daughter for new-onset
visual hallucinations of small children and animals in the corner
of the room. He is lucid, not distressed, and has mild cognitive
deficits on MMSE (24/30). Which of the following are the most
likely diagnoses to consider in the differential?
A. Dementia with Lewy Bodies
B. Psychotic Disorder Due to Another Medical Condition
(Parkinson's disease)
C. Schizophrenia
D. Delirium
E. Major Neurocognitive Disorder Due to Alzheimer's Disease
Correct Answer: A, B
Rationale: Well-formed, non-distressing visual hallucinations
are a core diagnostic feature of Dementia with Lewy Bodies
(DLB). In the context of known Parkinson's disease, these
psychotic symptoms are also directly attributable to the
underlying neurodegenerative process, making Psychotic
Disorder Due to PD a valid diagnosis. Schizophrenia onset in late
life without prior history is exceedingly rare. Delirium typically
presents with acute confusion and fluctuating consciousness,
not lucid, chronic hallucinations. Alzheimer's disease typically
,presents with memory impairment first and visual
hallucinations are less common early on.
Q3. A 9-year-old boy is referred for assessment. His teacher
reports he frequently blurts out answers, has difficulty waiting
his turn, and often interrupts peers. At home, his parents note
he loses toys, forgets chores, and seems not to listen. However,
during a 50-minute office evaluation, he sits quietly, engages
appropriately, and completes tasks. Which assessment step is
most critical for accurate diagnosis?
A. Diagnose ADHD, Combined Presentation based on school
report.
B. Administer a continuous performance test (CPT) in the office.
C. Obtain standardized rating scales from multiple settings
(parents, teachers).
D. Rule out Autism Spectrum Disorder based on his good social
engagement.
Correct Answer: C
Rationale: DSM-5-TR requires that symptoms be present in two
or more settings (e.g., home and school) for an ADHD diagnosis.
The discrepancy between reported behavior and office
observation is classic; ADHD symptoms may not manifest in
novel, one-on-one, highly stimulating environments. Collateral
rating scales (e.g., Vanderbilt, Conners) from multiple sources
are the gold standard for assessment. A CPT is a useful objective
measure but cannot alone confirm or rule out ADHD. Ruling out
, ASD is not the immediate next step given the clear ADHD
symptom profile.
Q4. A 35-year-old woman presents with a 2-year history of
recurrent, intrusive thoughts that she may have accidentally hit
a pedestrian while driving. She experiences intense anxiety and
spends hours retracing her routes or watching news for reports
of hit-and-runs. These thoughts are ego-dystonic and she
recognizes they are excessive. She has no history of trauma
related to driving. The most likely diagnosis is:
A. Posttraumatic Stress Disorder
B. Illness Anxiety Disorder
C. Obsessive-Compulsive Disorder
D. Generalized Anxiety Disorder
Correct Answer: C
Rationale: The presentation is classic for OCD: recurrent,
intrusive, unwanted thoughts (obsessions) about causing harm,
leading to compulsive behaviors (retracing, checking news)
performed to neutralize the anxiety. The thoughts are ego-
dystonic (inconsistent with her self-view). PTSD requires
exposure to an actual traumatic event. Illness Anxiety Disorder
focuses on fear of having a serious illness. GAD involves
excessive, uncontrollable worry about multiple real-life
concerns, not typically accompanied by such specific, ritualized
compulsions.
Q5. A 42-year-old man with a history of alcohol use disorder
(sober 5 years) presents with episodes of palpitations, chest
College of Nursing | Differential Diagnosis in
Psychiatric-Mental Health Practicum | 50-Q&A
Test Bank & Rationales
Q1. A 24-year-old graduate student presents with a 6-month
history of pervasive low mood, anhedonia, significant weight
gain, hypersomnia (sleeping 12+ hours daily), and a heavy,
leaden feeling in her limbs. She reports these symptoms are
consistently worse in the winter months and improve each
spring. Her PHQ-9 score is 18. She has no history of mania. The
most accurate diagnosis is:
A. Major Depressive Disorder, recurrent
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Major Depressive Disorder with Seasonal Pattern
Correct Answer: D
Rationale: While MDD recurrent is plausible, the key
discriminating feature is the clear, recurring temporal
relationship to seasons (winter worsening, spring improvement)
which meets criteria for the "with seasonal pattern" specifier.
The "atypical" features (weight gain, hypersomnia, leaden
paralysis) are commonly associated with seasonal depression.
,There is no indication of hypomania to suggest Bipolar II, and
the episode duration and severity are more acute than
Persistent Depressive Disorder.
Q2. (Select All That Apply) A 68-year-old man with a history of
Parkinson's disease is brought in by his daughter for new-onset
visual hallucinations of small children and animals in the corner
of the room. He is lucid, not distressed, and has mild cognitive
deficits on MMSE (24/30). Which of the following are the most
likely diagnoses to consider in the differential?
A. Dementia with Lewy Bodies
B. Psychotic Disorder Due to Another Medical Condition
(Parkinson's disease)
C. Schizophrenia
D. Delirium
E. Major Neurocognitive Disorder Due to Alzheimer's Disease
Correct Answer: A, B
Rationale: Well-formed, non-distressing visual hallucinations
are a core diagnostic feature of Dementia with Lewy Bodies
(DLB). In the context of known Parkinson's disease, these
psychotic symptoms are also directly attributable to the
underlying neurodegenerative process, making Psychotic
Disorder Due to PD a valid diagnosis. Schizophrenia onset in late
life without prior history is exceedingly rare. Delirium typically
presents with acute confusion and fluctuating consciousness,
not lucid, chronic hallucinations. Alzheimer's disease typically
,presents with memory impairment first and visual
hallucinations are less common early on.
Q3. A 9-year-old boy is referred for assessment. His teacher
reports he frequently blurts out answers, has difficulty waiting
his turn, and often interrupts peers. At home, his parents note
he loses toys, forgets chores, and seems not to listen. However,
during a 50-minute office evaluation, he sits quietly, engages
appropriately, and completes tasks. Which assessment step is
most critical for accurate diagnosis?
A. Diagnose ADHD, Combined Presentation based on school
report.
B. Administer a continuous performance test (CPT) in the office.
C. Obtain standardized rating scales from multiple settings
(parents, teachers).
D. Rule out Autism Spectrum Disorder based on his good social
engagement.
Correct Answer: C
Rationale: DSM-5-TR requires that symptoms be present in two
or more settings (e.g., home and school) for an ADHD diagnosis.
The discrepancy between reported behavior and office
observation is classic; ADHD symptoms may not manifest in
novel, one-on-one, highly stimulating environments. Collateral
rating scales (e.g., Vanderbilt, Conners) from multiple sources
are the gold standard for assessment. A CPT is a useful objective
measure but cannot alone confirm or rule out ADHD. Ruling out
, ASD is not the immediate next step given the clear ADHD
symptom profile.
Q4. A 35-year-old woman presents with a 2-year history of
recurrent, intrusive thoughts that she may have accidentally hit
a pedestrian while driving. She experiences intense anxiety and
spends hours retracing her routes or watching news for reports
of hit-and-runs. These thoughts are ego-dystonic and she
recognizes they are excessive. She has no history of trauma
related to driving. The most likely diagnosis is:
A. Posttraumatic Stress Disorder
B. Illness Anxiety Disorder
C. Obsessive-Compulsive Disorder
D. Generalized Anxiety Disorder
Correct Answer: C
Rationale: The presentation is classic for OCD: recurrent,
intrusive, unwanted thoughts (obsessions) about causing harm,
leading to compulsive behaviors (retracing, checking news)
performed to neutralize the anxiety. The thoughts are ego-
dystonic (inconsistent with her self-view). PTSD requires
exposure to an actual traumatic event. Illness Anxiety Disorder
focuses on fear of having a serious illness. GAD involves
excessive, uncontrollable worry about multiple real-life
concerns, not typically accompanied by such specific, ritualized
compulsions.
Q5. A 42-year-old man with a history of alcohol use disorder
(sober 5 years) presents with episodes of palpitations, chest
