NR 547 Final Exam 2025/2026 Test Bank |
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 45-year-old woman presents with a 10-month history of
depressed mood, early morning awakening, 6-kg weight loss,
psychomotor retardation, and profound guilt. She reports
occasional fleeting suicidal thoughts without plan. She also has
two lifetime hypomanic episodes lasting 3 days each with
increased energy and decreased need for sleep but no
impairment. Which diagnosis best fits?
,A. Major Depressive Disorder, recurrent, severe with
melancholic features
B. Bipolar II Disorder, current episode depressed
C. Persistent Depressive Disorder (Dysthymia)
D. Cyclothymic Disorder
Correct Answer: B
Rationale: The long depressive episode with classic melancholic
features could be major depression, but the history of
hypomanic episodes (short, 3 days) indicates Bipolar II. Bipolar
II requires hypomania (not full mania) and depressive episodes.
Dysthymia is chronic subsyndromal depression; cyclothymia
entails chronic fluctuating hypomanic and depressive symptoms
not meeting full criteria.
Q2. A 28-year-old male presents with 6 months of excessive
worry about work, muscle tension, restlessness, and difficulty
concentrating. He also reports two panic attacks in the past
month. He worries about job performance and death from a
heart attack despite cardiac clearance. Which diagnosis is most
likely?
A. Generalized Anxiety Disorder (GAD)
B. Panic Disorder with agoraphobia
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: A
Rationale: Excessive worry across domains for ≥6 months with
associated symptoms (muscle tension, restlessness,
,concentration problems) meets GAD. Panic attacks can occur
comorbidly; panic disorder requires recurrent unexpected panic
attacks with persistent concern about attacks or maladaptive
change—here worry is generalized rather than focused on
panic.
Q3. A 35-year-old veteran reports nightmares, hypervigilance,
and avoidance of reminders of an IED blast 9 months ago. He
also has persistent negative beliefs about himself and others
and detachment from family. Which feature distinguishes PTSD
from Acute Stress Disorder in this case?
A. Presence of nightmares
B. Avoidance behaviors
C. Duration greater than one month
D. Hypervigilance
Correct Answer: C
Rationale: PTSD and Acute Stress Disorder share symptom
clusters; the key differentiator is duration: ASD is from 3 days to
1 month after trauma; PTSD requires symptoms persisting >1
month. Other symptoms are common to both.
Q4. A 22-year-old college student presents with auditory
hallucinations commanding self-harm, flat affect, social
withdrawal, onset over 3 weeks, and catatonic-like rigidity for
hours. Which diagnosis is most consistent?
A. Schizophrenia
B. Brief Psychotic Disorder
, C. Schizoaffective Disorder
D. Delusional Disorder
Correct Answer: B
Rationale: Psychotic symptoms with duration <1 month suggest
Brief Psychotic Disorder. Schizophrenia requires ≥6 months
(including 1 month active-phase). Schizoaffective requires mood
episode plus psychosis; delusional disorder lacks prominent
hallucinations or disorganization.
Q5. An 80-year-old man with progressive memory decline for 3
years, impaired orientation, executive dysfunction, and
fluctuating attention is found to have visual hallucinations and
parkinsonism. Which diagnosis is most likely?
A. Alzheimer’s disease dementia
B. Vascular dementia
C. Dementia with Lewy Bodies (DLB)
D. Frontotemporal dementia
Correct Answer: C
Rationale: Visual hallucinations, parkinsonism, fluctuating
cognition are classic for DLB. Alzheimer’s typically begins with
memory impairment without prominent early visual
hallucinations or parkinsonism. Vascular dementia shows
stepwise decline; frontotemporal features early behavioral
changes and language problems.
Q6. A 10-year-old boy has been inattentive in class for 9
months, often loses things, and avoids homework. He also has
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 45-year-old woman presents with a 10-month history of
depressed mood, early morning awakening, 6-kg weight loss,
psychomotor retardation, and profound guilt. She reports
occasional fleeting suicidal thoughts without plan. She also has
two lifetime hypomanic episodes lasting 3 days each with
increased energy and decreased need for sleep but no
impairment. Which diagnosis best fits?
,A. Major Depressive Disorder, recurrent, severe with
melancholic features
B. Bipolar II Disorder, current episode depressed
C. Persistent Depressive Disorder (Dysthymia)
D. Cyclothymic Disorder
Correct Answer: B
Rationale: The long depressive episode with classic melancholic
features could be major depression, but the history of
hypomanic episodes (short, 3 days) indicates Bipolar II. Bipolar
II requires hypomania (not full mania) and depressive episodes.
Dysthymia is chronic subsyndromal depression; cyclothymia
entails chronic fluctuating hypomanic and depressive symptoms
not meeting full criteria.
Q2. A 28-year-old male presents with 6 months of excessive
worry about work, muscle tension, restlessness, and difficulty
concentrating. He also reports two panic attacks in the past
month. He worries about job performance and death from a
heart attack despite cardiac clearance. Which diagnosis is most
likely?
A. Generalized Anxiety Disorder (GAD)
B. Panic Disorder with agoraphobia
C. Social Anxiety Disorder
D. Specific Phobia
Correct Answer: A
Rationale: Excessive worry across domains for ≥6 months with
associated symptoms (muscle tension, restlessness,
,concentration problems) meets GAD. Panic attacks can occur
comorbidly; panic disorder requires recurrent unexpected panic
attacks with persistent concern about attacks or maladaptive
change—here worry is generalized rather than focused on
panic.
Q3. A 35-year-old veteran reports nightmares, hypervigilance,
and avoidance of reminders of an IED blast 9 months ago. He
also has persistent negative beliefs about himself and others
and detachment from family. Which feature distinguishes PTSD
from Acute Stress Disorder in this case?
A. Presence of nightmares
B. Avoidance behaviors
C. Duration greater than one month
D. Hypervigilance
Correct Answer: C
Rationale: PTSD and Acute Stress Disorder share symptom
clusters; the key differentiator is duration: ASD is from 3 days to
1 month after trauma; PTSD requires symptoms persisting >1
month. Other symptoms are common to both.
Q4. A 22-year-old college student presents with auditory
hallucinations commanding self-harm, flat affect, social
withdrawal, onset over 3 weeks, and catatonic-like rigidity for
hours. Which diagnosis is most consistent?
A. Schizophrenia
B. Brief Psychotic Disorder
, C. Schizoaffective Disorder
D. Delusional Disorder
Correct Answer: B
Rationale: Psychotic symptoms with duration <1 month suggest
Brief Psychotic Disorder. Schizophrenia requires ≥6 months
(including 1 month active-phase). Schizoaffective requires mood
episode plus psychosis; delusional disorder lacks prominent
hallucinations or disorganization.
Q5. An 80-year-old man with progressive memory decline for 3
years, impaired orientation, executive dysfunction, and
fluctuating attention is found to have visual hallucinations and
parkinsonism. Which diagnosis is most likely?
A. Alzheimer’s disease dementia
B. Vascular dementia
C. Dementia with Lewy Bodies (DLB)
D. Frontotemporal dementia
Correct Answer: C
Rationale: Visual hallucinations, parkinsonism, fluctuating
cognition are classic for DLB. Alzheimer’s typically begins with
memory impairment without prominent early visual
hallucinations or parkinsonism. Vascular dementia shows
stepwise decline; frontotemporal features early behavioral
changes and language problems.
Q6. A 10-year-old boy has been inattentive in class for 9
months, often loses things, and avoids homework. He also has
