NR 547 Final Exam 2025/2026 | Chamberlain
College | Differential Diagnosis in Psychiatric-
Mental Health | 50 Advanced Practice
Questions & Answers | PMHNP Test Bank &
Study Guide
Q1. A 24-year-old graduate student presents with a 3-week
history of pervasive sadness, anhedonia, and hypersomnia. She
reports a 10-pound weight gain and daily crying spells. She
states, "I feel like a lead weight is on my chest, and I can barely
move." She denies suicidal ideation. Her symptoms began
shortly after her boyfriend ended their relationship. Her PHQ-9
score is 18. Past psychiatric history is negative. What is the most
appropriate provisional diagnosis?
A. Major Depressive Disorder
B. Adjustment Disorder with Depressed Mood
C. Persistent Depressive Disorder (Dysthymia)
D. Uncomplicated Bereavement
Correct Answer: A
Rationale: While the onset was preceded by a psychosocial
stressor, the symptom cluster meets full DSM-5-TR criteria for a
,Major Depressive Episode (depressed mood, anhedonia,
significant weight change, hypersomnia, psychomotor
retardation implied by "lead weight," and functional
impairment). The severity (PHQ-9 >15) and number/duration of
symptoms exceed the criteria for Adjustment Disorder.
Persistent Depressive Disorder requires a duration of at least
two years. Bereavement is not applicable as the loss was a
romantic relationship, not a death.
Q2. A 70-year-old man with a history of hypertension and
hyperlipidemia is brought in by his daughter for "increasing
confusion." Over the past 8 months, he has had a subtle decline
in his ability to manage finances and remember recent
conversations. In the past 3 months, he has become apathetic,
lost interest in his gardening hobby, and had two episodes of
getting lost while driving to the grocery store. Neurological
exam is non-focal. MoCA score is 22/30, with deficits in delayed
recall, attention, and orientation. What neurocognitive disorder
is most likely?
A. Alzheimer’s Disease
B. Vascular Neurocognitive Disorder
C. Major Neurocognitive Disorder due to Lewy Body Disease
D. Frontotemporal Neurocognitive Disorder
Correct Answer: A
Rationale: The insidious onset and progressive course of
prominent memory impairment (amnestic presentation) plus
deficits in another cognitive domain (executive function), with
,no evidence of cerebrovascular events or prominent visual
hallucinations/motor parkinsonism, point most typically to
Alzheimer’s Disease. Vascular NCD often shows a stepwise
decline and focal neurological signs. Lewy Body features include
fluctuating cognition, visual hallucinations, and REM sleep
behavior disorder. Frontotemporal NCD typically presents with
earlier personality/behavioral or language changes.
Q3. (Select All That Apply) A 45-year-old woman presents with a
20-year history of interpersonal volatility, frantic efforts to avoid
abandonment, recurrent suicidal gestures, and chronic feelings
of emptiness. Which of the following features would also
support a DSM-5-TR diagnosis of Borderline Personality
Disorder? Select three.
A. Transient, stress-related paranoid ideation
B. Pathological lying and lack of remorse
C. Identity disturbance with unstable self-image
D. Inappropriate, intense anger
E. Grandiose sense of self-importance
Correct Answer: A, C, D
Rationale: A, C, and D are direct diagnostic criteria for BPD
(DSM-5-TR Criterion 9, 3, and 8 respectively). Pathological lying
and lack of remorse are core features of Antisocial Personality
Disorder. Grandiose sense of self-importance is a criterion for
Narcissistic Personality Disorder.
Q4. A 9-year-old boy is referred for evaluation of "always being
in trouble at school." His teacher reports he frequently blurts
, out answers, leaves his seat, and talks excessively during quiet
work time. At home, he has difficulty waiting his turn in games
and often loses things. Symptoms have been present since
kindergarten and occur in both school and home settings. His
academic performance is average. What is the most critical next
step in assessment?
A. Prescribe a trial of long-acting methylphenidate.
B. Administer parent and teacher ADHD rating scales.
C. Order an EEG to rule out absence seizures.
D. Diagnose Combined Presentation ADHD.
Correct Answer: B
Rationale: While the vignette is classic for ADHD, DSM-5-TR
diagnosis requires information from multiple sources (e.g.,
parents, teachers) to confirm pervasiveness across settings and
rule out other causes. Rating scales are a standardized,
evidence-based component of this multi-method assessment.
Prescribing (A) is premature before a full diagnostic assessment.
Absence seizures (C) typically present as brief staring spells, not
pervasive hyperactive/impulsive behavior. Making a formal
diagnosis (D) is incorrect prior to gathering the necessary
corroborating information and ensuring all diagnostic criteria
are fully met.
Q5. A 28-year-old woman presents with a 6-month history of
joint pain, headaches, and abdominal discomfort. She has seen
multiple specialists, had extensive negative workups (including
rheumatology, gastroenterology, and neurology), and remains
College | Differential Diagnosis in Psychiatric-
Mental Health | 50 Advanced Practice
Questions & Answers | PMHNP Test Bank &
Study Guide
Q1. A 24-year-old graduate student presents with a 3-week
history of pervasive sadness, anhedonia, and hypersomnia. She
reports a 10-pound weight gain and daily crying spells. She
states, "I feel like a lead weight is on my chest, and I can barely
move." She denies suicidal ideation. Her symptoms began
shortly after her boyfriend ended their relationship. Her PHQ-9
score is 18. Past psychiatric history is negative. What is the most
appropriate provisional diagnosis?
A. Major Depressive Disorder
B. Adjustment Disorder with Depressed Mood
C. Persistent Depressive Disorder (Dysthymia)
D. Uncomplicated Bereavement
Correct Answer: A
Rationale: While the onset was preceded by a psychosocial
stressor, the symptom cluster meets full DSM-5-TR criteria for a
,Major Depressive Episode (depressed mood, anhedonia,
significant weight change, hypersomnia, psychomotor
retardation implied by "lead weight," and functional
impairment). The severity (PHQ-9 >15) and number/duration of
symptoms exceed the criteria for Adjustment Disorder.
Persistent Depressive Disorder requires a duration of at least
two years. Bereavement is not applicable as the loss was a
romantic relationship, not a death.
Q2. A 70-year-old man with a history of hypertension and
hyperlipidemia is brought in by his daughter for "increasing
confusion." Over the past 8 months, he has had a subtle decline
in his ability to manage finances and remember recent
conversations. In the past 3 months, he has become apathetic,
lost interest in his gardening hobby, and had two episodes of
getting lost while driving to the grocery store. Neurological
exam is non-focal. MoCA score is 22/30, with deficits in delayed
recall, attention, and orientation. What neurocognitive disorder
is most likely?
A. Alzheimer’s Disease
B. Vascular Neurocognitive Disorder
C. Major Neurocognitive Disorder due to Lewy Body Disease
D. Frontotemporal Neurocognitive Disorder
Correct Answer: A
Rationale: The insidious onset and progressive course of
prominent memory impairment (amnestic presentation) plus
deficits in another cognitive domain (executive function), with
,no evidence of cerebrovascular events or prominent visual
hallucinations/motor parkinsonism, point most typically to
Alzheimer’s Disease. Vascular NCD often shows a stepwise
decline and focal neurological signs. Lewy Body features include
fluctuating cognition, visual hallucinations, and REM sleep
behavior disorder. Frontotemporal NCD typically presents with
earlier personality/behavioral or language changes.
Q3. (Select All That Apply) A 45-year-old woman presents with a
20-year history of interpersonal volatility, frantic efforts to avoid
abandonment, recurrent suicidal gestures, and chronic feelings
of emptiness. Which of the following features would also
support a DSM-5-TR diagnosis of Borderline Personality
Disorder? Select three.
A. Transient, stress-related paranoid ideation
B. Pathological lying and lack of remorse
C. Identity disturbance with unstable self-image
D. Inappropriate, intense anger
E. Grandiose sense of self-importance
Correct Answer: A, C, D
Rationale: A, C, and D are direct diagnostic criteria for BPD
(DSM-5-TR Criterion 9, 3, and 8 respectively). Pathological lying
and lack of remorse are core features of Antisocial Personality
Disorder. Grandiose sense of self-importance is a criterion for
Narcissistic Personality Disorder.
Q4. A 9-year-old boy is referred for evaluation of "always being
in trouble at school." His teacher reports he frequently blurts
, out answers, leaves his seat, and talks excessively during quiet
work time. At home, he has difficulty waiting his turn in games
and often loses things. Symptoms have been present since
kindergarten and occur in both school and home settings. His
academic performance is average. What is the most critical next
step in assessment?
A. Prescribe a trial of long-acting methylphenidate.
B. Administer parent and teacher ADHD rating scales.
C. Order an EEG to rule out absence seizures.
D. Diagnose Combined Presentation ADHD.
Correct Answer: B
Rationale: While the vignette is classic for ADHD, DSM-5-TR
diagnosis requires information from multiple sources (e.g.,
parents, teachers) to confirm pervasiveness across settings and
rule out other causes. Rating scales are a standardized,
evidence-based component of this multi-method assessment.
Prescribing (A) is premature before a full diagnostic assessment.
Absence seizures (C) typically present as brief staring spells, not
pervasive hyperactive/impulsive behavior. Making a formal
diagnosis (D) is incorrect prior to gathering the necessary
corroborating information and ensuring all diagnostic criteria
are fully met.
Q5. A 28-year-old woman presents with a 6-month history of
joint pain, headaches, and abdominal discomfort. She has seen
multiple specialists, had extensive negative workups (including
rheumatology, gastroenterology, and neurology), and remains
