NR 547 Final Exam 2025/2026 | Chamberlain
College of Nursing | Differential Diagnosis in
Psychiatric-Mental Health Practicum | 50
Comprehensive Q&A with Rationale | PMHNP
Exam Prep
Q1. A 72-year-old widow is brought in by her daughter for
increased social withdrawal and lethargy over 4 months. She
states, "What's the point? I'm just a burden since my Henry
died." She has lost 12 pounds, sleeps poorly with early morning
awakening, and has stopped attending her book club. Her
MMSE score is 28/30. Her symptoms began 2 months after her
husband's death from cancer. What is the most likely diagnosis?
A. Major Depressive Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Uncomplicated Bereavement
D. Adjustment Disorder with Depressed Mood
Correct Answer: A
Rationale: This presentation exceeds the normal bounds of
,bereavement. While the loss occurred 6 months ago, the
presence of prominent, persistent depressive symptoms
(worthlessness, significant weight loss, anhedonia, sleep
disturbance) with functional impairment for 4 months meets
criteria for Major Depressive Episode (MDE). The timeline rules
out uncomplicated bereavement, which typically improves
within 6-12 months. The late onset and clear precipitant do not
preclude an MDE diagnosis.
Q2. A 24-year-old graduate student presents with a 6-month
history of fluctuating fatigue, muscle aches, and "brain fog." She
has seen multiple specialists, keeping a detailed log of
symptoms, and is convinced she has Lyme disease despite
repeatedly negative tests. She becomes tearful and angry when
her concerns are not validated. A thorough medical workup is
unremarkable. What is the primary diagnosis to consider?
A. Illness Anxiety Disorder
B. Somatic Symptom Disorder
C. Conversion Disorder (Functional Neurological Symptom
Disorder)
D. Factitious Disorder
Correct Answer: B
Rationale: Somatic Symptom Disorder is characterized by one
or more distressing somatic symptoms accompanied by
excessive thoughts, feelings, and behaviors related to the health
concerns. This patient's high health anxiety, disproportionate
and persistent thoughts about the seriousness of her
,symptoms, and excessive time/energy devoted to health
concerns are key features. Illness Anxiety Disorder typically
involves minimal somatic symptoms; the focus is on fear of
having a disease. There is no evidence of intentional feigning
(Factitious) or neurological symptom presentation (Conversion).
Q3. An 8-year-old boy is referred for evaluation. His teacher
reports he frequently blurts out answers, leaves his seat, and
has trouble taking turns. At home, he loses toys, forgets chores,
and his room is chaotic. Symptoms have been present since
kindergarten and occur in both settings. Intellectual testing
shows above-average ability. What is the NEXT most critical step
in the diagnostic assessment?
A. Diagnose ADHD, Combined Presentation and start a
stimulant trial.
B. Administer standardized parent and teacher ADHD rating
scales.
C. Order a sleep study to rule out sleep apnea.
D. Assess for symptoms of childhood-onset bipolar disorder.
Correct Answer: B
Rationale: While the history is suggestive of ADHD, diagnosis
requires confirmation that symptoms are developmentally
inappropriate, pervasive, and cause impairment. The gold
standard involves using norm-referenced rating scales from
multiple settings (e.g., Vanderbilt, Conners) to objectify and
quantify reports from parents and teachers. This must precede
treatment initiation. Sleep disorders can mimic ADHD and
, should be considered, but rating scales are a more immediate
next step. Childhood bipolar disorder is characterized by
episodic, distinct mood episodes, not chronic pervasive
inattention/impulsivity.
Q4. A 45-year-old man with a history of alcohol use disorder
(sober 5 years) presents with a 3-week history of declining
function. He is disoriented, has profound anterograde amnesia,
and confabulates stories about his recent activities. He exhibits
horizontal nystagmus and mild ataxia. His wife states his diet
has been poor recently. What is the most likely diagnosis?
A. Alzheimer's Disease
B. Korsakoff Syndrome
C. Wernicke Encephalopathy
D. Delirium Tremens
Correct Answer: C
Rationale: The classic triad of Wernicke Encephalopathy is
encephalopathy (confusion), oculomotor abnormalities
(nystagmus), and gait ataxia. It is caused by thiamine (B1)
deficiency, commonly seen in malnutrition associated with
chronic alcohol use. While Korsakoff syndrome (chronic
amnestic disorder) often follows Wernicke's, the acute
presentation with the full triad points to Wernicke
Encephalopathy. Delirium Tremens is characterized by
autonomic hyperactivity and hallucinations occurring during
alcohol withdrawal, not the classic triad.
College of Nursing | Differential Diagnosis in
Psychiatric-Mental Health Practicum | 50
Comprehensive Q&A with Rationale | PMHNP
Exam Prep
Q1. A 72-year-old widow is brought in by her daughter for
increased social withdrawal and lethargy over 4 months. She
states, "What's the point? I'm just a burden since my Henry
died." She has lost 12 pounds, sleeps poorly with early morning
awakening, and has stopped attending her book club. Her
MMSE score is 28/30. Her symptoms began 2 months after her
husband's death from cancer. What is the most likely diagnosis?
A. Major Depressive Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Uncomplicated Bereavement
D. Adjustment Disorder with Depressed Mood
Correct Answer: A
Rationale: This presentation exceeds the normal bounds of
,bereavement. While the loss occurred 6 months ago, the
presence of prominent, persistent depressive symptoms
(worthlessness, significant weight loss, anhedonia, sleep
disturbance) with functional impairment for 4 months meets
criteria for Major Depressive Episode (MDE). The timeline rules
out uncomplicated bereavement, which typically improves
within 6-12 months. The late onset and clear precipitant do not
preclude an MDE diagnosis.
Q2. A 24-year-old graduate student presents with a 6-month
history of fluctuating fatigue, muscle aches, and "brain fog." She
has seen multiple specialists, keeping a detailed log of
symptoms, and is convinced she has Lyme disease despite
repeatedly negative tests. She becomes tearful and angry when
her concerns are not validated. A thorough medical workup is
unremarkable. What is the primary diagnosis to consider?
A. Illness Anxiety Disorder
B. Somatic Symptom Disorder
C. Conversion Disorder (Functional Neurological Symptom
Disorder)
D. Factitious Disorder
Correct Answer: B
Rationale: Somatic Symptom Disorder is characterized by one
or more distressing somatic symptoms accompanied by
excessive thoughts, feelings, and behaviors related to the health
concerns. This patient's high health anxiety, disproportionate
and persistent thoughts about the seriousness of her
,symptoms, and excessive time/energy devoted to health
concerns are key features. Illness Anxiety Disorder typically
involves minimal somatic symptoms; the focus is on fear of
having a disease. There is no evidence of intentional feigning
(Factitious) or neurological symptom presentation (Conversion).
Q3. An 8-year-old boy is referred for evaluation. His teacher
reports he frequently blurts out answers, leaves his seat, and
has trouble taking turns. At home, he loses toys, forgets chores,
and his room is chaotic. Symptoms have been present since
kindergarten and occur in both settings. Intellectual testing
shows above-average ability. What is the NEXT most critical step
in the diagnostic assessment?
A. Diagnose ADHD, Combined Presentation and start a
stimulant trial.
B. Administer standardized parent and teacher ADHD rating
scales.
C. Order a sleep study to rule out sleep apnea.
D. Assess for symptoms of childhood-onset bipolar disorder.
Correct Answer: B
Rationale: While the history is suggestive of ADHD, diagnosis
requires confirmation that symptoms are developmentally
inappropriate, pervasive, and cause impairment. The gold
standard involves using norm-referenced rating scales from
multiple settings (e.g., Vanderbilt, Conners) to objectify and
quantify reports from parents and teachers. This must precede
treatment initiation. Sleep disorders can mimic ADHD and
, should be considered, but rating scales are a more immediate
next step. Childhood bipolar disorder is characterized by
episodic, distinct mood episodes, not chronic pervasive
inattention/impulsivity.
Q4. A 45-year-old man with a history of alcohol use disorder
(sober 5 years) presents with a 3-week history of declining
function. He is disoriented, has profound anterograde amnesia,
and confabulates stories about his recent activities. He exhibits
horizontal nystagmus and mild ataxia. His wife states his diet
has been poor recently. What is the most likely diagnosis?
A. Alzheimer's Disease
B. Korsakoff Syndrome
C. Wernicke Encephalopathy
D. Delirium Tremens
Correct Answer: C
Rationale: The classic triad of Wernicke Encephalopathy is
encephalopathy (confusion), oculomotor abnormalities
(nystagmus), and gait ataxia. It is caused by thiamine (B1)
deficiency, commonly seen in malnutrition associated with
chronic alcohol use. While Korsakoff syndrome (chronic
amnestic disorder) often follows Wernicke's, the acute
presentation with the full triad points to Wernicke
Encephalopathy. Delirium Tremens is characterized by
autonomic hyperactivity and hallucinations occurring during
alcohol withdrawal, not the classic triad.
