NR 547 Final Exam 2025/2026 | Chamberlain
College of Nursing | Differential Diagnosis in
Psychiatric-Mental Health Across the Lifespan
Practicum | 50 High-Difficulty Q&A | DSM-5-
TR Based | Advanced PMHNP Clinical
Reasoning Guide
Q1. A 28-year-old female presents with a 3-week history of
persistently low mood, anhedonia, poor concentration, and
insomnia. She reports a 10-pound weight loss. She states these
symptoms began abruptly two days after her husband was
killed in a motor vehicle accident. She is preoccupied with guilt,
stating, "I should have made him take the bus that day." She
reports vivid, intrusive memories of identifying his body at the
morgue and avoids driving past the hospital. Her mental status
exam is notable for psychomotor retardation and a flat affect.
What is the most accurate initial diagnosis?
A. Major Depressive Disorder, Single Episode
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with Depressed Mood
,D. Posttraumatic Stress Disorder with Prominent Depressive
Symptoms
Correct Answer: A
Rationale: While the precipitant is a traumatic stressor, the
symptom cluster and duration meet full criteria for a Major
Depressive Episode (MDE): depressed mood, anhedonia, weight
loss, insomnia, psychomotor changes, guilt, and concentration
problems for >2 weeks. The intrusive memories and avoidance
are congruent with acute grief and trauma exposure but are not
the full, organized cluster required for PTSD. The acuity and
severity of symptoms rule out Persistent Depressive Disorder.
Adjustment Disorder is not used when criteria for another
disorder (like MDE) are met.
Q2. A 72-year-old male with a history of hypertension and Type
2 Diabetes is brought in by his daughter for "increasing
confusion." Over the past 8 months, he has had a gradual
decline in his ability to manage finances and remember
appointments. In the past 3 months, he has gotten lost driving
to his regular grocery store. He is often irritable and has
developed a belief that his neighbors are stealing his
newspapers. Neurological exam is non-focal, but cognitive
testing shows significant deficits in orientation, recall, and
visuospatial abilities. An MRI shows diffuse cortical atrophy and
hippocampal volume loss. What is the most likely
neurocognitive disorder?
A. Vascular Neurocognitive Disorder
,B. Alzheimer's Disease
C. Frontotemporal Neurocognitive Disorder
D. Neurocognitive Disorder Due to Lewy Body Disease
Correct Answer: B
Rationale: The key features are an insidious onset and gradual
progression of cognitive decline, most prominently in memory
(amnestic presentation) and later in visuospatial abilities,
leading to significant functional impairment. The
neuropsychiatric symptom of non-bizarre delusions (theft) is
common in moderate stages. The MRI findings support
Alzheimer's pathology. The absence of a clear stepwise decline
or focal neurological signs makes Vascular less likely. Lack of
core features of Lewy Body (fluctuating cognition, detailed
visual hallucinations, parkinsonism) or prominent early
behavioral/personality changes (Frontotemporal) points to
Alzheimer's.
Q3. (Select All That Apply) A 16-year-old adolescent is evaluated
for chronic school difficulties. Which of the following
presentations would be MOST consistent with a diagnosis of
Specific Learning Disorder, as opposed to ADHD or Intellectual
Disability? Select three.
A. Discrepancy between overall intellectual ability (IQ 105) and
standardized academic achievement test scores in written
expression (which are severely impaired).
B. A history of global developmental delays in motor, language,
and social skills since early childhood.
, C. Academic performance that is significantly impaired across all
domains (reading, math, written expression) and correlated
with low scores across all cognitive index scores.
D. Difficulty mastering spelling and grammar rules, with written
work being disorganized and nearly illegible, despite adequate
effort and instruction.
E. Teacher reports describing the student as "careless,"
"forgetting assignments," and "unable to stay seated during
independent work time," while one-on-one testing reveals
grade-level skills.
Correct Answer: A, D, E
Rationale: A & D exemplify the DSM-5-TR core criterion of
specific academic skills deficits that are substantially below
expectations for age, persist for >6 months, and are not better
explained by other factors. E describes behaviors classic for
ADHD (inattention, hyperactivity) that interfere with
performance, but when tested in a controlled setting, the
underlying skill is intact, arguing against a Learning Disorder. B
suggests global delays, more aligned with Intellectual Disability.
C describes pervasive low achievement correlated with low
cognitive ability, which argues against a specific learning
disorder.
Q4. A 45-year-old male presents stating, "My new psychiatrist
says I'm bipolar, but I disagree." He reports chronic, continuous
feelings of emptiness, intense anger outbursts, and a pattern of
unstable relationships since his teens. He endorses recent
College of Nursing | Differential Diagnosis in
Psychiatric-Mental Health Across the Lifespan
Practicum | 50 High-Difficulty Q&A | DSM-5-
TR Based | Advanced PMHNP Clinical
Reasoning Guide
Q1. A 28-year-old female presents with a 3-week history of
persistently low mood, anhedonia, poor concentration, and
insomnia. She reports a 10-pound weight loss. She states these
symptoms began abruptly two days after her husband was
killed in a motor vehicle accident. She is preoccupied with guilt,
stating, "I should have made him take the bus that day." She
reports vivid, intrusive memories of identifying his body at the
morgue and avoids driving past the hospital. Her mental status
exam is notable for psychomotor retardation and a flat affect.
What is the most accurate initial diagnosis?
A. Major Depressive Disorder, Single Episode
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with Depressed Mood
,D. Posttraumatic Stress Disorder with Prominent Depressive
Symptoms
Correct Answer: A
Rationale: While the precipitant is a traumatic stressor, the
symptom cluster and duration meet full criteria for a Major
Depressive Episode (MDE): depressed mood, anhedonia, weight
loss, insomnia, psychomotor changes, guilt, and concentration
problems for >2 weeks. The intrusive memories and avoidance
are congruent with acute grief and trauma exposure but are not
the full, organized cluster required for PTSD. The acuity and
severity of symptoms rule out Persistent Depressive Disorder.
Adjustment Disorder is not used when criteria for another
disorder (like MDE) are met.
Q2. A 72-year-old male with a history of hypertension and Type
2 Diabetes is brought in by his daughter for "increasing
confusion." Over the past 8 months, he has had a gradual
decline in his ability to manage finances and remember
appointments. In the past 3 months, he has gotten lost driving
to his regular grocery store. He is often irritable and has
developed a belief that his neighbors are stealing his
newspapers. Neurological exam is non-focal, but cognitive
testing shows significant deficits in orientation, recall, and
visuospatial abilities. An MRI shows diffuse cortical atrophy and
hippocampal volume loss. What is the most likely
neurocognitive disorder?
A. Vascular Neurocognitive Disorder
,B. Alzheimer's Disease
C. Frontotemporal Neurocognitive Disorder
D. Neurocognitive Disorder Due to Lewy Body Disease
Correct Answer: B
Rationale: The key features are an insidious onset and gradual
progression of cognitive decline, most prominently in memory
(amnestic presentation) and later in visuospatial abilities,
leading to significant functional impairment. The
neuropsychiatric symptom of non-bizarre delusions (theft) is
common in moderate stages. The MRI findings support
Alzheimer's pathology. The absence of a clear stepwise decline
or focal neurological signs makes Vascular less likely. Lack of
core features of Lewy Body (fluctuating cognition, detailed
visual hallucinations, parkinsonism) or prominent early
behavioral/personality changes (Frontotemporal) points to
Alzheimer's.
Q3. (Select All That Apply) A 16-year-old adolescent is evaluated
for chronic school difficulties. Which of the following
presentations would be MOST consistent with a diagnosis of
Specific Learning Disorder, as opposed to ADHD or Intellectual
Disability? Select three.
A. Discrepancy between overall intellectual ability (IQ 105) and
standardized academic achievement test scores in written
expression (which are severely impaired).
B. A history of global developmental delays in motor, language,
and social skills since early childhood.
, C. Academic performance that is significantly impaired across all
domains (reading, math, written expression) and correlated
with low scores across all cognitive index scores.
D. Difficulty mastering spelling and grammar rules, with written
work being disorganized and nearly illegible, despite adequate
effort and instruction.
E. Teacher reports describing the student as "careless,"
"forgetting assignments," and "unable to stay seated during
independent work time," while one-on-one testing reveals
grade-level skills.
Correct Answer: A, D, E
Rationale: A & D exemplify the DSM-5-TR core criterion of
specific academic skills deficits that are substantially below
expectations for age, persist for >6 months, and are not better
explained by other factors. E describes behaviors classic for
ADHD (inattention, hyperactivity) that interfere with
performance, but when tested in a controlled setting, the
underlying skill is intact, arguing against a Learning Disorder. B
suggests global delays, more aligned with Intellectual Disability.
C describes pervasive low achievement correlated with low
cognitive ability, which argues against a specific learning
disorder.
Q4. A 45-year-old male presents stating, "My new psychiatrist
says I'm bipolar, but I disagree." He reports chronic, continuous
feelings of emptiness, intense anger outbursts, and a pattern of
unstable relationships since his teens. He endorses recent
