NR547 – Differential Diagnosis in Psychiatric-
Mental Health Across the Lifespan Practicum
Practice Exam 2026/2027 | Practice Questions
& Study Guide | Complete Exam-Style
Questions with Correct Detailed Answers &
Rationales (Reliable Answers) | Latest Updated
Version | Instant Download PDF
Question 1
A 34-year-old client presents with depressed mood, anhedonia,
fatigue, poor concentration, and insomnia for 6 weeks. The
client denies previous episodes of mania or hypomania. Which
diagnosis should be highest on the differential?
A. Persistent depressive disorder
B. Adjustment disorder with depressed mood
C. Major depressive disorder
D. Cyclothymic disorder
Rationale: Major depressive disorder is strongly supported when
a client has a sustained period of depressed mood or anhedonia
accompanied by multiple associated symptoms such as sleep
,disturbance, fatigue, impaired concentration, and functional
impairment. The symptoms described have persisted for 6
weeks, exceeding the minimum duration required for a major
depressive episode. Persistent depressive disorder requires a
substantially longer chronic course, while adjustment disorder
requires symptoms to occur in response to an identifiable
stressor and not meet criteria for another depressive disorder.
Cyclothymic disorder involves chronic fluctuations between
hypomanic and depressive symptoms rather than a discrete
major depressive episode.
Question 2
A client reports hearing voices that comment on behavior and
seeing figures that others cannot see. Which assessment
question is most important for distinguishing a primary
psychotic disorder from a medical or substance-induced
condition?
A. "Do you generally prefer to spend time alone?"
B. "Have you experienced similar symptoms during childhood?"
C. "When did the symptoms begin, and did they occur in
relation to medication, substance use, or a medical illness?"
D. "Do your family members believe your experiences are
unusual?"
,Rationale: Establishing the timing and relationship of psychotic
symptoms to substances, medications, and medical conditions is
essential in differential diagnosis. Psychosis can occur secondary
to intoxication, withdrawal, medications, neurologic disease,
endocrine abnormalities, metabolic disturbances, and other
medical conditions. A temporal relationship can substantially
change the diagnostic formulation and treatment plan. Social
preferences and family opinions may contribute to the
psychiatric history but are less useful for determining whether
the psychosis has a secondary cause.
Question 3
A 72-year-old hospitalized client develops sudden confusion,
fluctuating attention, disorganized thinking, and visual
hallucinations over 24 hours. Which diagnosis is most consistent
with this presentation?
A. Major neurocognitive disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Delirium
Rationale: Delirium is characterized by an acute disturbance in
attention and awareness accompanied by changes in cognition
that fluctuate over a relatively short period. In older adults,
hospitalization, infection, medications, metabolic disturbances,
, pain, dehydration, and environmental changes can precipitate
delirium. Major neurocognitive disorders generally develop
more gradually and produce persistent cognitive decline. The
abrupt onset and fluctuating attention in this case strongly
favor delirium.
Question 4
A client has experienced excessive worry about multiple areas
of life nearly every day for more than 6 months. The worry is
difficult to control and is accompanied by muscle tension,
irritability, fatigue, and sleep disturbance. Which diagnosis is
most appropriate?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Adjustment disorder
Rationale: Generalized anxiety disorder involves excessive
anxiety and worry about multiple events or activities occurring
more days than not for at least 6 months. The worry is difficult
to control and is accompanied by characteristic symptoms such
as restlessness, fatigue, concentration problems, irritability,
muscle tension, and sleep disturbance. Panic disorder centers on
recurrent unexpected panic attacks and associated concern
Mental Health Across the Lifespan Practicum
Practice Exam 2026/2027 | Practice Questions
& Study Guide | Complete Exam-Style
Questions with Correct Detailed Answers &
Rationales (Reliable Answers) | Latest Updated
Version | Instant Download PDF
Question 1
A 34-year-old client presents with depressed mood, anhedonia,
fatigue, poor concentration, and insomnia for 6 weeks. The
client denies previous episodes of mania or hypomania. Which
diagnosis should be highest on the differential?
A. Persistent depressive disorder
B. Adjustment disorder with depressed mood
C. Major depressive disorder
D. Cyclothymic disorder
Rationale: Major depressive disorder is strongly supported when
a client has a sustained period of depressed mood or anhedonia
accompanied by multiple associated symptoms such as sleep
,disturbance, fatigue, impaired concentration, and functional
impairment. The symptoms described have persisted for 6
weeks, exceeding the minimum duration required for a major
depressive episode. Persistent depressive disorder requires a
substantially longer chronic course, while adjustment disorder
requires symptoms to occur in response to an identifiable
stressor and not meet criteria for another depressive disorder.
Cyclothymic disorder involves chronic fluctuations between
hypomanic and depressive symptoms rather than a discrete
major depressive episode.
Question 2
A client reports hearing voices that comment on behavior and
seeing figures that others cannot see. Which assessment
question is most important for distinguishing a primary
psychotic disorder from a medical or substance-induced
condition?
A. "Do you generally prefer to spend time alone?"
B. "Have you experienced similar symptoms during childhood?"
C. "When did the symptoms begin, and did they occur in
relation to medication, substance use, or a medical illness?"
D. "Do your family members believe your experiences are
unusual?"
,Rationale: Establishing the timing and relationship of psychotic
symptoms to substances, medications, and medical conditions is
essential in differential diagnosis. Psychosis can occur secondary
to intoxication, withdrawal, medications, neurologic disease,
endocrine abnormalities, metabolic disturbances, and other
medical conditions. A temporal relationship can substantially
change the diagnostic formulation and treatment plan. Social
preferences and family opinions may contribute to the
psychiatric history but are less useful for determining whether
the psychosis has a secondary cause.
Question 3
A 72-year-old hospitalized client develops sudden confusion,
fluctuating attention, disorganized thinking, and visual
hallucinations over 24 hours. Which diagnosis is most consistent
with this presentation?
A. Major neurocognitive disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Delirium
Rationale: Delirium is characterized by an acute disturbance in
attention and awareness accompanied by changes in cognition
that fluctuate over a relatively short period. In older adults,
hospitalization, infection, medications, metabolic disturbances,
, pain, dehydration, and environmental changes can precipitate
delirium. Major neurocognitive disorders generally develop
more gradually and produce persistent cognitive decline. The
abrupt onset and fluctuating attention in this case strongly
favor delirium.
Question 4
A client has experienced excessive worry about multiple areas
of life nearly every day for more than 6 months. The worry is
difficult to control and is accompanied by muscle tension,
irritability, fatigue, and sleep disturbance. Which diagnosis is
most appropriate?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Adjustment disorder
Rationale: Generalized anxiety disorder involves excessive
anxiety and worry about multiple events or activities occurring
more days than not for at least 6 months. The worry is difficult
to control and is accompanied by characteristic symptoms such
as restlessness, fatigue, concentration problems, irritability,
muscle tension, and sleep disturbance. Panic disorder centers on
recurrent unexpected panic attacks and associated concern
