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 32-year-old presents with a 3-week history of pervasive
low mood, hypersomnia, increased appetite, psychomotor
retardation, and recurrent thoughts of worthlessness. She
reports a history of two distinct periods lasting ~8 days each
with elevated energy, decreased need for sleep, pressured
speech, and increased goal-directed activity that did not cause
marked impairment. What is the most likely primary diagnosis?
A. Major Depressive Disorder, single episode
B. Bipolar I Disorder, current episode depressed
C. Bipolar II Disorder, current episode depressed
D. Cyclothymic Disorder
Correct Answer: C
Rationale: DSM-5-TR requires hypomanic episodes (≥4 days)
with depressive episodes for Bipolar II; patient’s 8-day elevated
,periods meet hypomania and current 3-week depressive
episode meets MDE; no history of mania (which would indicate
Bipolar I).
Q2. A 45-year-old with chronic alcohol use develops 48 hours
after last drink: tremor, autonomic hyperactivity, visual
hallucinations, and disorientation. Which diagnosis best
explains the presentation?
A. Alcohol-induced psychotic disorder
B. Alcohol withdrawal delirium (delirium tremens)
C. Major neurocognitive disorder due to alcohol
D. Acute stress disorder
Correct Answer: B
Rationale: Onset within 48–72 hours after cessation with
fluctuating consciousness, autonomic signs, and visual
hallucinations points to alcohol withdrawal delirium; psychotic
disorder due to alcohol lacks the fluctuating attention and
disorientation typical of delirium.
Q3. A 14-year-old presents with persistent irritability, temper
outbursts (several times weekly) and a nearly daily irritable
mood for 10 months across settings. Which diagnosis is most
appropriate?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
,C. Intermittent Explosive Disorder
D. Major Depressive Disorder
Correct Answer: B
Rationale: DMDD requires severe recurrent temper outbursts
and persistent irritability for ≥12 months onset before 10–18
years and across settings; ODD lacks the pervasive chronic
irritability of DMDD and is differentiated by defiance rather
than mood dysregulation.
Q4. A 27-year-old reports 8 months of excessive worry about
multiple domains, difficulty controlling worry, muscle tension,
sleep disturbance, and impairment. Which feature most
differentiates Generalized Anxiety Disorder (GAD) from an
adjustment disorder with anxiety?
A. Presence of significant functional impairment
B. Worry about multiple events occurring more days than not
for ≥6 months
C. Onset within 3 months of a stressor
D. Prominent sleep disturbance
Correct Answer: B
Rationale: DSM-5-TR criterion for GAD includes excessive
anxiety and worry occurring more days than not for ≥6 months
about multiple events; adjustment disorder requires symptoms
arising within 3 months of stressor and typically resolves within
6 months of stressor removal.
, Q5. A 68-year-old man presents with progressive memory
impairment over 2 years, early visuospatial deficits, fluctuating
cognition, and visual hallucinations. Which diagnosis is most
consistent?
A. Alzheimer’s disease (major neurocognitive disorder)
B. Dementia with Lewy bodies (DLB)
C. Vascular neurocognitive disorder
D. Parkinson’s disease dementia
Correct Answer: B
Rationale: DLB features early visual hallucinations, fluctuating
cognition/attention, and visuospatial deficits; timing
distinguishes DLB (visual hallucinations and cognitive
fluctuations early) from Parkinson’s disease dementia (motor
symptoms precede dementia).
Q6. A patient reports recurrent intrusive memories, nightmares,
hypervigilance, and avoidance of reminders for 7 days after a
motor vehicle collision. What is the best diagnosis?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment Disorder with anxiety
D. Other specified trauma- and stressor-related disorder
Correct Answer: A
Rationale: Acute Stress Disorder is diagnosed for symptoms
Chamberlain PMHNP Differential Diagnosis
Across the Lifespan | 50 Graduate-Level
Questions & Answers | Nursing Exam Prep
Guide
Q1. A 32-year-old presents with a 3-week history of pervasive
low mood, hypersomnia, increased appetite, psychomotor
retardation, and recurrent thoughts of worthlessness. She
reports a history of two distinct periods lasting ~8 days each
with elevated energy, decreased need for sleep, pressured
speech, and increased goal-directed activity that did not cause
marked impairment. What is the most likely primary diagnosis?
A. Major Depressive Disorder, single episode
B. Bipolar I Disorder, current episode depressed
C. Bipolar II Disorder, current episode depressed
D. Cyclothymic Disorder
Correct Answer: C
Rationale: DSM-5-TR requires hypomanic episodes (≥4 days)
with depressive episodes for Bipolar II; patient’s 8-day elevated
,periods meet hypomania and current 3-week depressive
episode meets MDE; no history of mania (which would indicate
Bipolar I).
Q2. A 45-year-old with chronic alcohol use develops 48 hours
after last drink: tremor, autonomic hyperactivity, visual
hallucinations, and disorientation. Which diagnosis best
explains the presentation?
A. Alcohol-induced psychotic disorder
B. Alcohol withdrawal delirium (delirium tremens)
C. Major neurocognitive disorder due to alcohol
D. Acute stress disorder
Correct Answer: B
Rationale: Onset within 48–72 hours after cessation with
fluctuating consciousness, autonomic signs, and visual
hallucinations points to alcohol withdrawal delirium; psychotic
disorder due to alcohol lacks the fluctuating attention and
disorientation typical of delirium.
Q3. A 14-year-old presents with persistent irritability, temper
outbursts (several times weekly) and a nearly daily irritable
mood for 10 months across settings. Which diagnosis is most
appropriate?
A. Oppositional Defiant Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
,C. Intermittent Explosive Disorder
D. Major Depressive Disorder
Correct Answer: B
Rationale: DMDD requires severe recurrent temper outbursts
and persistent irritability for ≥12 months onset before 10–18
years and across settings; ODD lacks the pervasive chronic
irritability of DMDD and is differentiated by defiance rather
than mood dysregulation.
Q4. A 27-year-old reports 8 months of excessive worry about
multiple domains, difficulty controlling worry, muscle tension,
sleep disturbance, and impairment. Which feature most
differentiates Generalized Anxiety Disorder (GAD) from an
adjustment disorder with anxiety?
A. Presence of significant functional impairment
B. Worry about multiple events occurring more days than not
for ≥6 months
C. Onset within 3 months of a stressor
D. Prominent sleep disturbance
Correct Answer: B
Rationale: DSM-5-TR criterion for GAD includes excessive
anxiety and worry occurring more days than not for ≥6 months
about multiple events; adjustment disorder requires symptoms
arising within 3 months of stressor and typically resolves within
6 months of stressor removal.
, Q5. A 68-year-old man presents with progressive memory
impairment over 2 years, early visuospatial deficits, fluctuating
cognition, and visual hallucinations. Which diagnosis is most
consistent?
A. Alzheimer’s disease (major neurocognitive disorder)
B. Dementia with Lewy bodies (DLB)
C. Vascular neurocognitive disorder
D. Parkinson’s disease dementia
Correct Answer: B
Rationale: DLB features early visual hallucinations, fluctuating
cognition/attention, and visuospatial deficits; timing
distinguishes DLB (visual hallucinations and cognitive
fluctuations early) from Parkinson’s disease dementia (motor
symptoms precede dementia).
Q6. A patient reports recurrent intrusive memories, nightmares,
hypervigilance, and avoidance of reminders for 7 days after a
motor vehicle collision. What is the best diagnosis?
A. Acute Stress Disorder
B. Posttraumatic Stress Disorder (PTSD)
C. Adjustment Disorder with anxiety
D. Other specified trauma- and stressor-related disorder
Correct Answer: A
Rationale: Acute Stress Disorder is diagnosed for symptoms
