NR 547 Final Exam 2025/2026 |
Chamberlain College of Nursing |
Differential Diagnosis in Psychiatric–
Mental Health Practicum | 50 Graduate-
Level Q&A | Test Bank & PMHNP Prep
Guide [2025 Edition]
**Q1.** A 24-year-old female presents with a 2-week history of
persistently low mood, anhedonia, fatigue, and hypersomnia.
She reports a 10-pound weight gain and describes her limbs as
feeling "heavy and leaden." She has no prior psychiatric history.
Her PHQ-9 score is 18. What feature of this presentation is
*most* indicative of Major Depressive Disorder (MDD) *with*
atypical features, as opposed to MDD with melancholic
features?
A. The presence of anhedonia
B. The duration of symptoms (2 weeks)
C. Significant weight gain and hypersomnia
D. The absence of psychotic features
,**Correct Answer: C**
**Rationale:** While anhedonia (A) and duration (B) are
criteria for MDD, the key differentiator for the atypical features
specifier is mood reactivity *plus* at least two of: significant
weight gain/appetite increase, hypersomnia, leaden paralysis,
and long-standing interpersonal rejection sensitivity. Weight
gain and hypersomnia directly contrast with the weight loss and
insomnia common in melancholic features.
**Q2.** A 70-year-old man with a history of hypertension and
Type 2 Diabetes is brought in by his daughter for "increasing
confusion." Over the past 9 months, he has had a stepwise
decline in function. He has periods of relative clarity, but has
had three distinct episodes of sudden worsening involving
disorientation and gait instability, each lasting 2-3 days, with
partial recovery. His MRI shows multiple bilateral subcortical
infarcts. What is the most likely neurocognitive disorder?
A. Major Neurocognitive Disorder Due to Alzheimer’s Disease
B. Delirium, superimposed on an unspecified neurocognitive
disorder
C. Major Neurocognitive Disorder Due to Vascular Disease
C. Major Neurocognitive Disorder with Lewy Bodies
,**Correct Answer: C**
**Rationale:** The stepwise decline, history of vascular risk
factors (HTN, DM), and imaging evidence of multiple infarcts
are classic for Vascular Neurocognitive Disorder. The fluctuating
course can mimic Delirium (B) or Lewy Body Dementia (D), but
the clear correlation with cerebrovascular events and imaging
findings is pathognomonic for a vascular etiology.
**Q3.** A 16-year-old is evaluated for school refusal. He
reports intense fear of having a panic attack in the classroom
where he might not be able to escape. He has begun avoiding
assemblies, the cafeteria, and now refuses to enter the school
building. He has panic attacks approximately twice weekly,
characterized by palpitations, dizziness, and fear of dying. What
is the primary diagnosis?
A. Social Anxiety Disorder
B. Agoraphobia
C. Panic Disorder
D. Separation Anxiety Disorder
**Correct Answer: B**
**Rationale:** While Panic Disorder (C) is present, the
diagnostic criteria for Agoraphobia involve marked fear or
anxiety about two or more situations (e.g., using public
, transportation, being in open or enclosed spaces, standing in
line, being outside the home alone) due to thoughts that
escape might be difficult or help unavailable if panic-like
symptoms occur. The avoidance of multiple situations
(classroom, cafeteria, assemblies) due to fear of panic is the
defining feature of Agoraphobia, which can be diagnosed with
or without comorbid Panic Disorder.
**Q4.** A 45-year-old woman presents with a 6-month history
of pervasive sadness, poor concentration, and low energy. She
endorses chronic, low-grade depressive symptoms for "as long
as I can remember," but notes this recent episode is markedly
worse. She has never had manic/hypomanic symptoms,
psychosis, or significant functional recovery between episodes.
Her current episode meets full criteria for MDD. What is the
most accurate diagnosis?
A. Persistent Depressive Disorder (Dysthymia)
B. Major Depressive Disorder, recurrent
C. Major Depressive Disorder, single episode, with persistent
depressive disorder (double depression)
D. Cyclothymic Disorder
**Correct Answer: C**
Chamberlain College of Nursing |
Differential Diagnosis in Psychiatric–
Mental Health Practicum | 50 Graduate-
Level Q&A | Test Bank & PMHNP Prep
Guide [2025 Edition]
**Q1.** A 24-year-old female presents with a 2-week history of
persistently low mood, anhedonia, fatigue, and hypersomnia.
She reports a 10-pound weight gain and describes her limbs as
feeling "heavy and leaden." She has no prior psychiatric history.
Her PHQ-9 score is 18. What feature of this presentation is
*most* indicative of Major Depressive Disorder (MDD) *with*
atypical features, as opposed to MDD with melancholic
features?
A. The presence of anhedonia
B. The duration of symptoms (2 weeks)
C. Significant weight gain and hypersomnia
D. The absence of psychotic features
,**Correct Answer: C**
**Rationale:** While anhedonia (A) and duration (B) are
criteria for MDD, the key differentiator for the atypical features
specifier is mood reactivity *plus* at least two of: significant
weight gain/appetite increase, hypersomnia, leaden paralysis,
and long-standing interpersonal rejection sensitivity. Weight
gain and hypersomnia directly contrast with the weight loss and
insomnia common in melancholic features.
**Q2.** A 70-year-old man with a history of hypertension and
Type 2 Diabetes is brought in by his daughter for "increasing
confusion." Over the past 9 months, he has had a stepwise
decline in function. He has periods of relative clarity, but has
had three distinct episodes of sudden worsening involving
disorientation and gait instability, each lasting 2-3 days, with
partial recovery. His MRI shows multiple bilateral subcortical
infarcts. What is the most likely neurocognitive disorder?
A. Major Neurocognitive Disorder Due to Alzheimer’s Disease
B. Delirium, superimposed on an unspecified neurocognitive
disorder
C. Major Neurocognitive Disorder Due to Vascular Disease
C. Major Neurocognitive Disorder with Lewy Bodies
,**Correct Answer: C**
**Rationale:** The stepwise decline, history of vascular risk
factors (HTN, DM), and imaging evidence of multiple infarcts
are classic for Vascular Neurocognitive Disorder. The fluctuating
course can mimic Delirium (B) or Lewy Body Dementia (D), but
the clear correlation with cerebrovascular events and imaging
findings is pathognomonic for a vascular etiology.
**Q3.** A 16-year-old is evaluated for school refusal. He
reports intense fear of having a panic attack in the classroom
where he might not be able to escape. He has begun avoiding
assemblies, the cafeteria, and now refuses to enter the school
building. He has panic attacks approximately twice weekly,
characterized by palpitations, dizziness, and fear of dying. What
is the primary diagnosis?
A. Social Anxiety Disorder
B. Agoraphobia
C. Panic Disorder
D. Separation Anxiety Disorder
**Correct Answer: B**
**Rationale:** While Panic Disorder (C) is present, the
diagnostic criteria for Agoraphobia involve marked fear or
anxiety about two or more situations (e.g., using public
, transportation, being in open or enclosed spaces, standing in
line, being outside the home alone) due to thoughts that
escape might be difficult or help unavailable if panic-like
symptoms occur. The avoidance of multiple situations
(classroom, cafeteria, assemblies) due to fear of panic is the
defining feature of Agoraphobia, which can be diagnosed with
or without comorbid Panic Disorder.
**Q4.** A 45-year-old woman presents with a 6-month history
of pervasive sadness, poor concentration, and low energy. She
endorses chronic, low-grade depressive symptoms for "as long
as I can remember," but notes this recent episode is markedly
worse. She has never had manic/hypomanic symptoms,
psychosis, or significant functional recovery between episodes.
Her current episode meets full criteria for MDD. What is the
most accurate diagnosis?
A. Persistent Depressive Disorder (Dysthymia)
B. Major Depressive Disorder, recurrent
C. Major Depressive Disorder, single episode, with persistent
depressive disorder (double depression)
D. Cyclothymic Disorder
**Correct Answer: C**
