,NR 547 CEA Exam | Differential Diagnosis
Practicum (2026) Q&A | Chamberlain College
1. The PMHNP is evaluating a new patient who reports depressed mood, fatigue, and weight
gain. Which of the following actions is the most critical first step in formulating a differential
diagnosis?
A) Order a TSH level and complete metabolic panel.
B) Initiate a low-dose SSRI and schedule follow-up.
C) Rule out physical and substance-related causes of the symptoms.
D) Administer the PHQ-9 and GAD-7 screening tools.
Correct Answer: C) Rule out physical and substance-related causes of the symptoms.
Rationale: The initial step in differential diagnosis is to exclude general medical conditions
and substance-induced etiologies before concluding a primary psychiatric disorder. This
prevents misattribution and ensures reversible causes are addressed. Laboratory testing and
screening instruments are subsequent steps, not the first priority.
2. A client with schizophrenia is started on clozapine. Which laboratory parameter must be
monitored regularly due to the risk of agranulocytosis?
A) Absolute neutrophil count (ANC)
B) Serum creatinine and BUN
C) Alanine aminotransferase (ALT)
D) Fasting plasma glucose
Correct Answer: A) Absolute neutrophil count (ANC)
Rationale: Clozapine carries a boxed warning for severe neutropenia. The FDA mandates ANC
monitoring at baseline, weekly during titration, and regularly thereafter. Although metabolic
,monitoring is needed for antipsychotics, ANC specifically addresses clozapine’s
agranulocytosis risk.
3. According to the DSM-5-TR, which of the following is a positive symptom of schizophrenia?
A) Affective flattening
B) Avolition
C) Alogia
D) Disorganized speech
Correct Answer: D) Disorganized speech
Rationale: Positive symptoms involve excess or distortion of normal functions and include
hallucinations, delusions, and disorganized speech. Negative symptoms, such as affective
flattening, avolition, and alogia, reflect diminished emotional expression, motivation, and
speech output. Accurate symptom classification guides treatment.
4. A 28-year-old patient reports recurrent, unexpected panic attacks and persistent worry
about future attacks for over a month. The PMHNP diagnoses panic disorder. Which DSM-5
criterion is essential to rule out before confirming this diagnosis?
A) Presence of agoraphobia
B) The attacks are not due to substance use or a medical condition
C) At least one attack must occur during sleep
D) A first-degree relative with panic disorder
Correct Answer: B) The attacks are not due to substance use or a medical condition
Rationale: DSM-5 stipulates that panic attacks must not be attributable to physiological
effects of a substance or another medical condition. Agoraphobia is a separate specifier, not a
requirement. Sleep attacks and family history are not diagnostic criteria, making exclusion of
medical/substance causes essential.
, 5. A patient taking risperidone for 6 months develops involuntary tongue movements and lip
smacking. Which screening tool should the PMHNP use to assess for tardive dyskinesia?
A) Generalized Anxiety Disorder-7 (GAD-7)
B) Hamilton Anxiety Rating Scale (HAM-A)
C) Patient Health Questionnaire-9 (PHQ-9)
D) Abnormal Involuntary Movement Scale (AIMS)
Correct Answer: D) Abnormal Involuntary Movement Scale (AIMS)
Rationale: The AIMS is specifically designed to detect and monitor tardive dyskinesia, a
movement disorder linked to antipsychotics. Anxiety and depression scales (GAD-7, HAM-A,
PHQ-9) are not designed to assess extrapyramidal or dyskinetic movements. Regular AIMS
examinations are recommended for patients on long-term antipsychotics.
6. When conducting a Mental Status Exam, which domain evaluates the patient’s awareness
of their illness and need for treatment?
A) Mood
B) Insight
C) Thought process
D) Cognition
Correct Answer: B) Insight
Rationale: Insight refers to the patient’s understanding of their psychiatric condition and the
necessity of treatment. Mood assesses sustained emotional state, thought process examines
the form of thinking, and cognition covers memory and orientation. Impaired insight is
common in psychotic disorders.
Practicum (2026) Q&A | Chamberlain College
1. The PMHNP is evaluating a new patient who reports depressed mood, fatigue, and weight
gain. Which of the following actions is the most critical first step in formulating a differential
diagnosis?
A) Order a TSH level and complete metabolic panel.
B) Initiate a low-dose SSRI and schedule follow-up.
C) Rule out physical and substance-related causes of the symptoms.
D) Administer the PHQ-9 and GAD-7 screening tools.
Correct Answer: C) Rule out physical and substance-related causes of the symptoms.
Rationale: The initial step in differential diagnosis is to exclude general medical conditions
and substance-induced etiologies before concluding a primary psychiatric disorder. This
prevents misattribution and ensures reversible causes are addressed. Laboratory testing and
screening instruments are subsequent steps, not the first priority.
2. A client with schizophrenia is started on clozapine. Which laboratory parameter must be
monitored regularly due to the risk of agranulocytosis?
A) Absolute neutrophil count (ANC)
B) Serum creatinine and BUN
C) Alanine aminotransferase (ALT)
D) Fasting plasma glucose
Correct Answer: A) Absolute neutrophil count (ANC)
Rationale: Clozapine carries a boxed warning for severe neutropenia. The FDA mandates ANC
monitoring at baseline, weekly during titration, and regularly thereafter. Although metabolic
,monitoring is needed for antipsychotics, ANC specifically addresses clozapine’s
agranulocytosis risk.
3. According to the DSM-5-TR, which of the following is a positive symptom of schizophrenia?
A) Affective flattening
B) Avolition
C) Alogia
D) Disorganized speech
Correct Answer: D) Disorganized speech
Rationale: Positive symptoms involve excess or distortion of normal functions and include
hallucinations, delusions, and disorganized speech. Negative symptoms, such as affective
flattening, avolition, and alogia, reflect diminished emotional expression, motivation, and
speech output. Accurate symptom classification guides treatment.
4. A 28-year-old patient reports recurrent, unexpected panic attacks and persistent worry
about future attacks for over a month. The PMHNP diagnoses panic disorder. Which DSM-5
criterion is essential to rule out before confirming this diagnosis?
A) Presence of agoraphobia
B) The attacks are not due to substance use or a medical condition
C) At least one attack must occur during sleep
D) A first-degree relative with panic disorder
Correct Answer: B) The attacks are not due to substance use or a medical condition
Rationale: DSM-5 stipulates that panic attacks must not be attributable to physiological
effects of a substance or another medical condition. Agoraphobia is a separate specifier, not a
requirement. Sleep attacks and family history are not diagnostic criteria, making exclusion of
medical/substance causes essential.
, 5. A patient taking risperidone for 6 months develops involuntary tongue movements and lip
smacking. Which screening tool should the PMHNP use to assess for tardive dyskinesia?
A) Generalized Anxiety Disorder-7 (GAD-7)
B) Hamilton Anxiety Rating Scale (HAM-A)
C) Patient Health Questionnaire-9 (PHQ-9)
D) Abnormal Involuntary Movement Scale (AIMS)
Correct Answer: D) Abnormal Involuntary Movement Scale (AIMS)
Rationale: The AIMS is specifically designed to detect and monitor tardive dyskinesia, a
movement disorder linked to antipsychotics. Anxiety and depression scales (GAD-7, HAM-A,
PHQ-9) are not designed to assess extrapyramidal or dyskinetic movements. Regular AIMS
examinations are recommended for patients on long-term antipsychotics.
6. When conducting a Mental Status Exam, which domain evaluates the patient’s awareness
of their illness and need for treatment?
A) Mood
B) Insight
C) Thought process
D) Cognition
Correct Answer: B) Insight
Rationale: Insight refers to the patient’s understanding of their psychiatric condition and the
necessity of treatment. Mood assesses sustained emotional state, thought process examines
the form of thinking, and cognition covers memory and orientation. Impaired insight is
common in psychotic disorders.
