NR 547 Final Exam Guide 2025/2026 |
Chamberlain PMHNP Differential Diagnosis |
50 Expert Q&A | DSM-5-TR Lifespan Psychiatry
Practicum Test Bank
Q1. A 72-year-old retired teacher is brought by her daughter for
increasing forgetfulness over 2 years. She frequently misplaces
items, repeats questions, and got lost driving to her familiar
grocery store last month. She is frustrated but minimizes
concerns. Neurological exam is normal except for mild
impairment on clock-drawing. MMSE is 24/30, with deficits in
recall and orientation. Which finding would be most suggestive
of Alzheimer's disease over other major neurocognitive
disorders?
A. Stepwise deterioration of function
B. Prominent visual hallucinations and parkinsonism
C. Significant fluctuations in attention and alertness
D. Steady, gradual decline with episodic memory impairment as
a prominent early feature
Correct Answer: D
Rationale: Alzheimer's disease typically presents with an
,insidious onset and gradual progression, with profound episodic
memory impairment (difficulty learning and recalling new
information) as a core early feature. Option A suggests vascular
etiology. Option B suggests Dementia with Lewy Bodies. Option
C also suggests Dementia with Lewy Bodies or delirium.
Q2. A 25-year-old graduate student presents with a 6-month
history of diminished interest in his thesis work, low energy, and
difficulty concentrating. He reports sleeping 10-12 hours daily, a
15-pound weight gain, and a feeling of "heaviness" in his limbs
that is worse in the evening. He denies anhedonia or suicidal
ideation. Which specifier is most appropriate for this major
depressive episode?
A. With melancholic features
B. With atypical features
C. With seasonal pattern
D. With peripartum onset
Correct Answer: C
Rationale: The presentation is classic for a seasonal pattern
(recurrent depressive episodes in fall/winter), characterized by
hypersomnia, hyperphagia/weight gain, leaden paralysis (heavy
feeling in limbs), and evening worsening. Atypical features also
include hypersomnia and hyperphagia, but the clear temporal
seasonal association takes precedence for the specifier.
Q3. (Select All That Apply) A 40-year-old woman presents with a
3-year history of persistent and excessive worry about her job
performance, her children's health, and household finances.
,She reports associated muscle tension, insomnia, and feeling
"on edge." She denies discrete panic attacks, trauma history, or
compulsive behaviors. She states the worry is difficult to control
and has caused significant distress. Which of the following must
also be present to meet DSM-5-TR criteria for Generalized
Anxiety Disorder?
A. Symptoms cause clinically significant distress or impairment.
B. The anxiety and worry are associated with three or more
specified symptoms (e.g., restlessness, muscle tension).
C. The anxiety and worry are not confined to features of
another Axis I disorder.
D. The disturbance is not attributable to the physiological
effects of a substance.
E. The worry occurs more days than not for at least 6 months.
Correct Answer: A, B, C, D, E
Rationale: All options are required DSM-5-TR diagnostic criteria
for GAD. A, B, D, and E are explicit criteria. C is a critical
differential criterion, stating the focus of anxiety is not better
explained by another disorder (e.g., panic disorder, social
anxiety, PTSD).
Q4. A 17-year-old adolescent is referred for academic decline
and odd behavior. His parents report he has become
increasingly isolative, spends hours writing incomprehensible
philosophical tracts, and believes his thoughts are being
broadcast on the school's PA system. Symptoms began subtly
about 10 months ago. There is no history of substance use. His
, affect is blunted and speech is slightly disorganized. What is the
most likely diagnosis?
A. Delusional Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Major Depressive Disorder with Psychotic Features
Correct Answer: B
Rationale: The presentation shows the classic prodrome of
schizophrenia in an adolescent, with functional decline and
characteristic positive (delusions of thought broadcasting) and
negative (social withdrawal, blunted affect) symptoms. The
duration (10 months) exceeds the 6-month requirement for
schizophrenia. Delusional disorder involves non-bizarre
delusions without other prominent psychotic symptoms or
functional decline. Schizoaffective requires a major mood
episode concurrent with the psychotic phase. MDD with
psychotic features would have mood symptoms as the primary
driver.
Q5. A 9-year-old boy is evaluated for behavioral problems at
school and home. Teachers report he often fails to give close
attention to details, makes careless mistakes, and does not
seem to listen when spoken to directly. He frequently loses his
assignments and is easily distracted. At home, he has difficulty
organizing tasks and avoids homework. Symptoms have been
present since first grade and occur in both settings. What is the
most critical next step in the diagnostic assessment?
Chamberlain PMHNP Differential Diagnosis |
50 Expert Q&A | DSM-5-TR Lifespan Psychiatry
Practicum Test Bank
Q1. A 72-year-old retired teacher is brought by her daughter for
increasing forgetfulness over 2 years. She frequently misplaces
items, repeats questions, and got lost driving to her familiar
grocery store last month. She is frustrated but minimizes
concerns. Neurological exam is normal except for mild
impairment on clock-drawing. MMSE is 24/30, with deficits in
recall and orientation. Which finding would be most suggestive
of Alzheimer's disease over other major neurocognitive
disorders?
A. Stepwise deterioration of function
B. Prominent visual hallucinations and parkinsonism
C. Significant fluctuations in attention and alertness
D. Steady, gradual decline with episodic memory impairment as
a prominent early feature
Correct Answer: D
Rationale: Alzheimer's disease typically presents with an
,insidious onset and gradual progression, with profound episodic
memory impairment (difficulty learning and recalling new
information) as a core early feature. Option A suggests vascular
etiology. Option B suggests Dementia with Lewy Bodies. Option
C also suggests Dementia with Lewy Bodies or delirium.
Q2. A 25-year-old graduate student presents with a 6-month
history of diminished interest in his thesis work, low energy, and
difficulty concentrating. He reports sleeping 10-12 hours daily, a
15-pound weight gain, and a feeling of "heaviness" in his limbs
that is worse in the evening. He denies anhedonia or suicidal
ideation. Which specifier is most appropriate for this major
depressive episode?
A. With melancholic features
B. With atypical features
C. With seasonal pattern
D. With peripartum onset
Correct Answer: C
Rationale: The presentation is classic for a seasonal pattern
(recurrent depressive episodes in fall/winter), characterized by
hypersomnia, hyperphagia/weight gain, leaden paralysis (heavy
feeling in limbs), and evening worsening. Atypical features also
include hypersomnia and hyperphagia, but the clear temporal
seasonal association takes precedence for the specifier.
Q3. (Select All That Apply) A 40-year-old woman presents with a
3-year history of persistent and excessive worry about her job
performance, her children's health, and household finances.
,She reports associated muscle tension, insomnia, and feeling
"on edge." She denies discrete panic attacks, trauma history, or
compulsive behaviors. She states the worry is difficult to control
and has caused significant distress. Which of the following must
also be present to meet DSM-5-TR criteria for Generalized
Anxiety Disorder?
A. Symptoms cause clinically significant distress or impairment.
B. The anxiety and worry are associated with three or more
specified symptoms (e.g., restlessness, muscle tension).
C. The anxiety and worry are not confined to features of
another Axis I disorder.
D. The disturbance is not attributable to the physiological
effects of a substance.
E. The worry occurs more days than not for at least 6 months.
Correct Answer: A, B, C, D, E
Rationale: All options are required DSM-5-TR diagnostic criteria
for GAD. A, B, D, and E are explicit criteria. C is a critical
differential criterion, stating the focus of anxiety is not better
explained by another disorder (e.g., panic disorder, social
anxiety, PTSD).
Q4. A 17-year-old adolescent is referred for academic decline
and odd behavior. His parents report he has become
increasingly isolative, spends hours writing incomprehensible
philosophical tracts, and believes his thoughts are being
broadcast on the school's PA system. Symptoms began subtly
about 10 months ago. There is no history of substance use. His
, affect is blunted and speech is slightly disorganized. What is the
most likely diagnosis?
A. Delusional Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Major Depressive Disorder with Psychotic Features
Correct Answer: B
Rationale: The presentation shows the classic prodrome of
schizophrenia in an adolescent, with functional decline and
characteristic positive (delusions of thought broadcasting) and
negative (social withdrawal, blunted affect) symptoms. The
duration (10 months) exceeds the 6-month requirement for
schizophrenia. Delusional disorder involves non-bizarre
delusions without other prominent psychotic symptoms or
functional decline. Schizoaffective requires a major mood
episode concurrent with the psychotic phase. MDD with
psychotic features would have mood symptoms as the primary
driver.
Q5. A 9-year-old boy is evaluated for behavioral problems at
school and home. Teachers report he often fails to give close
attention to details, makes careless mistakes, and does not
seem to listen when spoken to directly. He frequently loses his
assignments and is easily distracted. At home, he has difficulty
organizing tasks and avoids homework. Symptoms have been
present since first grade and occur in both settings. What is the
most critical next step in the diagnostic assessment?
