NR 547 Final Exam 2025/2026 Guide:
Chamberlain College Differential Diagnosis
in Psychiatric-Mental Health PMHNP
Practicum | 50 Expert Q&A, Rationale,
DSM-5-TR Prep for Lifespan Psych
Q1. A 24-year-old female presents with a 9-month history of
persistent sadness, anhedonia, 15-pound weight gain,
hypersomnia, leaden paralysis, and a lifelong pattern of
rejection sensitivity. She notes her mood is consistently worse
in the evenings. Her PHQ-9 score is 18. What is the most
accurate primary diagnosis?
A. Major Depressive Disorder, single episode, severe
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder with Atypical Features
D. Borderline Personality Disorder with comorbid depression
Correct Answer: C
Rationale: While Persistent Depressive Disorder involves
chronic low mood, the full syndrome of depressive symptoms
(anhedonia, weight change, sleep disturbance) lasting 9 months
meets criteria for a Major Depressive Episode. The specific
,symptom cluster of mood reactivity, weight gain, hypersomnia,
leaden paralysis, and rejection sensitivity is diagnostic of the
Atypical Features specifier. Evening worsening is common in
atypical depression. Borderline personality may be a
consideration but requires a broader pattern of instability; the
current presentation is dominated by the mood episode with
specific features.
Q2. A 16-year-old male is brought in by his parents for "strange
behavior." For the past 8 months, he has become increasingly
isolated, stopped seeing friends, and his grades have
plummeted. He reports hearing a voice commenting on his
actions in the third person and believes his thoughts are being
broadcast on the school's PA system. His affect is blunted. These
symptoms have caused significant dysfunction. Which diagnosis
is most supported?
A. Schizophrenia
B. Schizophreniform Disorder
C. Delusional Disorder
D. Autism Spectrum Disorder with psychotic features
Correct Answer: B
Rationale: The symptom profile (prominent auditory
hallucination, delusion of thought broadcasting, negative
symptoms, social/occupational dysfunction) clearly indicates a
psychotic disorder. For a diagnosis of Schizophrenia, symptoms
must persist for at least 6 months. This duration is 8 months,
which is over 6 months, but a key distinction is that
,Schizophreniform Disorder requires a duration of at least 1
month but less than 6 months. Therefore, with an 8-month
duration, Schizophrenia is the correct diagnosis. Answer B is a
distractor based on misreading the timeline. Delusional
Disorder involves non-bizarre delusions without other
prominent psychotic symptoms. Autism Spectrum Disorder
does not typically onset with psychosis in adolescence.
Q3. A 68-year-old man with a history of hypertension and Type
2 Diabetes is evaluated for a 2-year progressive decline in
memory. His wife notes he gets lost driving to familiar places,
has significant difficulty managing finances, and repeats
questions. Neurological exam is normal. MoCA score is 18/30,
with deficits in memory, orientation, and executive function.
Brain MRI shows moderate hippocampal atrophy and diffuse
cortical atrophy. What is the most likely neurocognitive
disorder?
A. Alzheimer's Disease
B. Vascular Neurocognitive Disorder
C. Frontotemporal Neurocognitive Disorder
D. Neurocognitive Disorder due to Lewy Body Disease
Correct Answer: A
Rationale: The insidious onset and progressive decline in
memory and other cognitive domains, with prominent memory
impairment early in the course, is classic for Alzheimer's
Disease. Neuroimaging showing hippocampal atrophy supports
this. While he has vascular risk factors, the absence of focal
, neurological signs or imaging evidence of significant
cerebrovascular disease (e.g., infarcts) makes Vascular NCD less
likely. Frontotemporal NCD typically presents with earlier
personality/behavior or language changes. Lewy Body Disease
is characterized by fluctuations, visual hallucinations, and
parkinsonism, which are not described.
Q4. (Select All That Apply) A 45-year-old woman presents with a
6-month history of excessive worry about her job, her children's
health, and household finances. She reports associated muscle
tension, insomnia, and feeling "on edge." She denies panic
attacks, obsessions, or trauma history. She states she has
"always been a worrier." Which of the following diagnoses must
be considered in the differential? Select all that apply.
A. Generalized Anxiety Disorder
B. Adjustment Disorder with Anxiety
C. Somatic Symptom Disorder
D. Persistent Depressive Disorder
E. Obsessive-Compulsive Disorder
Correct Answer: A, B, D
Rationale: A: GAD is characterized by excessive worry about
multiple domains for at least 6 months, accompanied by
physical symptoms like muscle tension and restlessness. B:
Adjustment Disorder can present with anxiety in response to a
stressor; the chronic worry about life circumstances warrants its
consideration. D: Persistent Depressive Disorder (dysthymia)
often includes chronic anxiety and worry as part of the
Chamberlain College Differential Diagnosis
in Psychiatric-Mental Health PMHNP
Practicum | 50 Expert Q&A, Rationale,
DSM-5-TR Prep for Lifespan Psych
Q1. A 24-year-old female presents with a 9-month history of
persistent sadness, anhedonia, 15-pound weight gain,
hypersomnia, leaden paralysis, and a lifelong pattern of
rejection sensitivity. She notes her mood is consistently worse
in the evenings. Her PHQ-9 score is 18. What is the most
accurate primary diagnosis?
A. Major Depressive Disorder, single episode, severe
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder with Atypical Features
D. Borderline Personality Disorder with comorbid depression
Correct Answer: C
Rationale: While Persistent Depressive Disorder involves
chronic low mood, the full syndrome of depressive symptoms
(anhedonia, weight change, sleep disturbance) lasting 9 months
meets criteria for a Major Depressive Episode. The specific
,symptom cluster of mood reactivity, weight gain, hypersomnia,
leaden paralysis, and rejection sensitivity is diagnostic of the
Atypical Features specifier. Evening worsening is common in
atypical depression. Borderline personality may be a
consideration but requires a broader pattern of instability; the
current presentation is dominated by the mood episode with
specific features.
Q2. A 16-year-old male is brought in by his parents for "strange
behavior." For the past 8 months, he has become increasingly
isolated, stopped seeing friends, and his grades have
plummeted. He reports hearing a voice commenting on his
actions in the third person and believes his thoughts are being
broadcast on the school's PA system. His affect is blunted. These
symptoms have caused significant dysfunction. Which diagnosis
is most supported?
A. Schizophrenia
B. Schizophreniform Disorder
C. Delusional Disorder
D. Autism Spectrum Disorder with psychotic features
Correct Answer: B
Rationale: The symptom profile (prominent auditory
hallucination, delusion of thought broadcasting, negative
symptoms, social/occupational dysfunction) clearly indicates a
psychotic disorder. For a diagnosis of Schizophrenia, symptoms
must persist for at least 6 months. This duration is 8 months,
which is over 6 months, but a key distinction is that
,Schizophreniform Disorder requires a duration of at least 1
month but less than 6 months. Therefore, with an 8-month
duration, Schizophrenia is the correct diagnosis. Answer B is a
distractor based on misreading the timeline. Delusional
Disorder involves non-bizarre delusions without other
prominent psychotic symptoms. Autism Spectrum Disorder
does not typically onset with psychosis in adolescence.
Q3. A 68-year-old man with a history of hypertension and Type
2 Diabetes is evaluated for a 2-year progressive decline in
memory. His wife notes he gets lost driving to familiar places,
has significant difficulty managing finances, and repeats
questions. Neurological exam is normal. MoCA score is 18/30,
with deficits in memory, orientation, and executive function.
Brain MRI shows moderate hippocampal atrophy and diffuse
cortical atrophy. What is the most likely neurocognitive
disorder?
A. Alzheimer's Disease
B. Vascular Neurocognitive Disorder
C. Frontotemporal Neurocognitive Disorder
D. Neurocognitive Disorder due to Lewy Body Disease
Correct Answer: A
Rationale: The insidious onset and progressive decline in
memory and other cognitive domains, with prominent memory
impairment early in the course, is classic for Alzheimer's
Disease. Neuroimaging showing hippocampal atrophy supports
this. While he has vascular risk factors, the absence of focal
, neurological signs or imaging evidence of significant
cerebrovascular disease (e.g., infarcts) makes Vascular NCD less
likely. Frontotemporal NCD typically presents with earlier
personality/behavior or language changes. Lewy Body Disease
is characterized by fluctuations, visual hallucinations, and
parkinsonism, which are not described.
Q4. (Select All That Apply) A 45-year-old woman presents with a
6-month history of excessive worry about her job, her children's
health, and household finances. She reports associated muscle
tension, insomnia, and feeling "on edge." She denies panic
attacks, obsessions, or trauma history. She states she has
"always been a worrier." Which of the following diagnoses must
be considered in the differential? Select all that apply.
A. Generalized Anxiety Disorder
B. Adjustment Disorder with Anxiety
C. Somatic Symptom Disorder
D. Persistent Depressive Disorder
E. Obsessive-Compulsive Disorder
Correct Answer: A, B, D
Rationale: A: GAD is characterized by excessive worry about
multiple domains for at least 6 months, accompanied by
physical symptoms like muscle tension and restlessness. B:
Adjustment Disorder can present with anxiety in response to a
stressor; the chronic worry about life circumstances warrants its
consideration. D: Persistent Depressive Disorder (dysthymia)
often includes chronic anxiety and worry as part of the
