NR 547 Final Exam 2025/2026 Study Guide |
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep Test
Bank
Q1. A 32-year-old presents with a 10-week history of low mood,
markedly diminished interest in previously pleasurable
activities, hypersomnia, increased appetite with 6-pound
weight gain, and impaired concentration. Symptoms are causing
occupational decline. There is no history of manic or hypomanic
episodes and no substance use. Which diagnosis is most likely?
A. Major depressive disorder, single episode
B. Persistent depressive disorder (dysthymia)
,C. Adjustment disorder with depressed mood
D. Bipolar II disorder
Correct Answer: A
Rationale: Duration >2 weeks and constellation of core MDD
symptoms (anhedonia, sleep/appetite changes, concentration
impairment) with significant functional impairment meet DSM-
5-TR criteria for Major Depressive Disorder. PDD requires ≥2
years, adjustment disorder requires identifiable stressor and
shorter course; Bipolar II requires past hypomania.
Q2. A patient reports 9 months of excessive worry about work,
family, and health, difficulty controlling worry, restlessness,
muscle tension, and insomnia nearly every day. Which feature
differentiates Generalized Anxiety Disorder from Major
Depressive Disorder with anxious distress?
A. Worry is pervasive and difficult to control for ≥6 months.
B. Presence of anhedonia and depressed mood.
C. Suicidal ideation.
D. Psychomotor retardation.
Correct Answer: A
Rationale: GAD is characterized by excessive, difficult-to-control
worry for ≥6 months with somatic symptoms (muscle tension,
restlessness). Anhedonia and depressed mood point to MDD;
suicidal ideation and psychomotor retardation are not
diagnostic differentiators for GAD.
,Q3. Select all that apply. Which findings most strongly suggest
Bipolar I disorder rather than Major Depressive Disorder?
A. A prior discrete week-long episode of elevated, expansive
mood with increased goal-directed activity and impaired
functioning requiring hospitalization.
B. Recurrent brief hypomanic episodes of 1–2 days duration
with no impairment.
C. Mood-congruent psychotic features only during major mood
episodes.
D. Family history of bipolar disorder and early-onset depressive
episodes.
Correct Answer: A, D
Rationale: Bipolar I requires at least one manic episode (≥1
week or any duration if hospitalization needed) causing marked
impairment; family history and early onset increase likelihood.
Brief 1–2 day hypomania does not meet hypomanic duration;
psychotic features confined to mood episodes occur in mood
disorders but are not pathognomonic for Bipolar I.
Q4. A 19-year-old college student has discrete panic attacks
over the past 6 months and now avoids leaving home alone
because of fear of having another attack and being unable to
escape. Which diagnosis best fits?
, A. Panic disorder without agoraphobia
B. Panic disorder with agoraphobia
C. Agoraphobia without history of panic disorder
D. Specific phobia
Correct Answer: B
Rationale: DSM-5-TR allows a diagnosis of panic disorder with
agoraphobia when recurrent unexpected panic attacks are
followed by persistent concern and avoidance of situations due
to fear of attacks. Agoraphobia without panic requires absence
of panic history. Specific phobia pertains to circumscribed
objects/situations.
Q5. A 45-year-old with 3 months of low mood, tearfulness,
insomnia, and difficulty concentrating after losing a job.
Symptoms are below the threshold for Major Depressive
Disorder and primarily in response to the job loss. Best
diagnosis?
A. Major depressive disorder
B. Adjustment disorder with depressed mood
C. Persistent depressive disorder
D. Bereavement
Correct Answer: B
Rationale: Adjustment disorder occurs when
emotional/behavioral symptoms develop within 3 months of an
identifiable stressor and cause impairment but do not meet
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep Test
Bank
Q1. A 32-year-old presents with a 10-week history of low mood,
markedly diminished interest in previously pleasurable
activities, hypersomnia, increased appetite with 6-pound
weight gain, and impaired concentration. Symptoms are causing
occupational decline. There is no history of manic or hypomanic
episodes and no substance use. Which diagnosis is most likely?
A. Major depressive disorder, single episode
B. Persistent depressive disorder (dysthymia)
,C. Adjustment disorder with depressed mood
D. Bipolar II disorder
Correct Answer: A
Rationale: Duration >2 weeks and constellation of core MDD
symptoms (anhedonia, sleep/appetite changes, concentration
impairment) with significant functional impairment meet DSM-
5-TR criteria for Major Depressive Disorder. PDD requires ≥2
years, adjustment disorder requires identifiable stressor and
shorter course; Bipolar II requires past hypomania.
Q2. A patient reports 9 months of excessive worry about work,
family, and health, difficulty controlling worry, restlessness,
muscle tension, and insomnia nearly every day. Which feature
differentiates Generalized Anxiety Disorder from Major
Depressive Disorder with anxious distress?
A. Worry is pervasive and difficult to control for ≥6 months.
B. Presence of anhedonia and depressed mood.
C. Suicidal ideation.
D. Psychomotor retardation.
Correct Answer: A
Rationale: GAD is characterized by excessive, difficult-to-control
worry for ≥6 months with somatic symptoms (muscle tension,
restlessness). Anhedonia and depressed mood point to MDD;
suicidal ideation and psychomotor retardation are not
diagnostic differentiators for GAD.
,Q3. Select all that apply. Which findings most strongly suggest
Bipolar I disorder rather than Major Depressive Disorder?
A. A prior discrete week-long episode of elevated, expansive
mood with increased goal-directed activity and impaired
functioning requiring hospitalization.
B. Recurrent brief hypomanic episodes of 1–2 days duration
with no impairment.
C. Mood-congruent psychotic features only during major mood
episodes.
D. Family history of bipolar disorder and early-onset depressive
episodes.
Correct Answer: A, D
Rationale: Bipolar I requires at least one manic episode (≥1
week or any duration if hospitalization needed) causing marked
impairment; family history and early onset increase likelihood.
Brief 1–2 day hypomania does not meet hypomanic duration;
psychotic features confined to mood episodes occur in mood
disorders but are not pathognomonic for Bipolar I.
Q4. A 19-year-old college student has discrete panic attacks
over the past 6 months and now avoids leaving home alone
because of fear of having another attack and being unable to
escape. Which diagnosis best fits?
, A. Panic disorder without agoraphobia
B. Panic disorder with agoraphobia
C. Agoraphobia without history of panic disorder
D. Specific phobia
Correct Answer: B
Rationale: DSM-5-TR allows a diagnosis of panic disorder with
agoraphobia when recurrent unexpected panic attacks are
followed by persistent concern and avoidance of situations due
to fear of attacks. Agoraphobia without panic requires absence
of panic history. Specific phobia pertains to circumscribed
objects/situations.
Q5. A 45-year-old with 3 months of low mood, tearfulness,
insomnia, and difficulty concentrating after losing a job.
Symptoms are below the threshold for Major Depressive
Disorder and primarily in response to the job loss. Best
diagnosis?
A. Major depressive disorder
B. Adjustment disorder with depressed mood
C. Persistent depressive disorder
D. Bereavement
Correct Answer: B
Rationale: Adjustment disorder occurs when
emotional/behavioral symptoms develop within 3 months of an
identifiable stressor and cause impairment but do not meet
