NR 547 Final Exam 2025/2026 Guide:
Chamberlain College of Nursing Differential
Diagnosis in Psychiatric-Mental Health
(PMHNP) | 50 Expert-Level Q&A with
Rationale | Test Bank & Study Resource
Q1. A 28-year-old male presents with a 9-month history of
persistently low mood, anhedonia, 15-pound weight gain,
hypersomnia nearly daily, feelings of leaden paralysis, and a
lifelong pattern of rejection sensitivity. He reports these
episodes occur regularly in the fall and winter, remitting fully in
the spring. What is the most accurate diagnosis?
A. Major Depressive Disorder, recurrent, with atypical features
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Major Depressive Disorder with seasonal pattern
Correct Answer: D
Rationale: The key differentiating feature is the clear seasonal
pattern (onset in fall/winter, full remission in spring) which
meets criteria for Major Depressive Disorder with seasonal
pattern (specifier). While the symptoms (weight gain,
hypersomnia, leaden paralysis, rejection sensitivity) are classic
,"atypical features," the seasonal pattern takes precedence in
diagnostic coding and is the central clue.
Q2. A 65-year-old female with no prior psychiatric history is
brought in by her daughter for a 4-month progressive decline.
She is apathetic, has significant psychomotor slowing, poor
hygiene, and blunt affect. She denies sadness or anhedonia.
Physical workup, including brain MRI and TSH, is normal. She
scores 28/30 on MMSE, missing points only on recall. What is
the most likely diagnosis?
A. Major Depressive Disorder
B. Alzheimer's Disease
C. Vascular Dementia
D. Depressive Disorder Due to Another Medical Condition
Correct Answer: A
Rationale: In older adults, depression can present with
prominent cognitive complaints ("pseudodementia") and a
predominance of psychomotor retardation/apathy rather than
overt sadness. The normal MMSE (recall loss is common in both
depression and dementia) and normal medical workup point to
a primary psychiatric etiology. The absence of a medical cause
rules out Option D.
Q3. A 19-year-old college student describes sudden,
overwhelming episodes of palpitations, chest pain, trembling,
and a fear of "going crazy" that peak within minutes. These
occur unexpectedly, at least once a week. She now avoids the
library and dining hall fearing an attack. What is the cornerstone
,diagnostic feature that differentiates this disorder from other
anxiety disorders?
A. The presence of anticipatory anxiety
B. The spontaneous, uncued nature of the panic attacks
C. The development of agoraphobic avoidance
D. The physical symptoms during the attack
Correct Answer: B
Rationale: While all options are features of Panic Disorder,
the spontaneous, uncued panic attack is the cornerstone.
Expected attacks in response to specific triggers are more
indicative of a specific phobia or social anxiety. The diagnosis
requires recurrent unexpected panic attacks followed by
persistent worry or behavioral change.
Q4. (Select All That Apply): A 42-year-old veteran with PTSD
from combat exposure presents for medication management.
Which of the following symptom clusters must be present to
meet DSM-5-TR criteria for PTSD? Select three.
A. Intrusive symptoms (e.g., memories, nightmares)
B. Persistent avoidance of stimuli associated with the trauma
C. Negative alterations in cognition and mood
D. Marked alterations in arousal and reactivity
E. Depersonalization or derealization
Correct Answer: A, B, C, D
Rationale: DSM-5-TR requires symptoms from all four clusters
(A-D) for a PTSD diagnosis. Cluster A (intrusion), B (avoidance),
C (negative cognitions/mood), and D (arousal).
, Depersonalization/derealization (E) is part of the dissociative
specifier, not a required criterion.
Q5. A 30-year-old man presents with a 2-week history of
grandiose delusions, decreased need for sleep, and pressured
speech. He was previously diagnosed with Schizoaffective
Disorder, Bipolar Type, 5 years ago and has had two similar
episodes requiring hospitalization. Between episodes, for the
past 18 months, he has had ongoing auditory commentary and
social withdrawal without prominent mood symptoms, despite
treatment. What is the most accurate diagnosis?
A. Bipolar I Disorder with psychotic features
B. Schizophrenia
C. Schizoaffective Disorder, Bipolar Type
D. Delusional Disorder
Correct Answer: C
Rationale: Schizoaffective Disorder requires: 1) A major mood
episode concurrent with active phase psychotic symptoms
(Criterion A). 2) Delusions or hallucinations for two or more
weeks in the absence of a major mood episode during the
illness's lifetime (Criterion B). This history describes psychotic
symptoms persisting between mood episodes, fulfilling
Criterion B and differentiating it from Bipolar I with psychotic
features.
Q6. A 78-year-old man with hypertension presents with a
stepwise decline in function. His cognitive deficits are "patchy" -
severe executive dysfunction and gait apraxia, but relatively
Chamberlain College of Nursing Differential
Diagnosis in Psychiatric-Mental Health
(PMHNP) | 50 Expert-Level Q&A with
Rationale | Test Bank & Study Resource
Q1. A 28-year-old male presents with a 9-month history of
persistently low mood, anhedonia, 15-pound weight gain,
hypersomnia nearly daily, feelings of leaden paralysis, and a
lifelong pattern of rejection sensitivity. He reports these
episodes occur regularly in the fall and winter, remitting fully in
the spring. What is the most accurate diagnosis?
A. Major Depressive Disorder, recurrent, with atypical features
B. Persistent Depressive Disorder (Dysthymia)
C. Bipolar II Disorder, current episode depressed
D. Major Depressive Disorder with seasonal pattern
Correct Answer: D
Rationale: The key differentiating feature is the clear seasonal
pattern (onset in fall/winter, full remission in spring) which
meets criteria for Major Depressive Disorder with seasonal
pattern (specifier). While the symptoms (weight gain,
hypersomnia, leaden paralysis, rejection sensitivity) are classic
,"atypical features," the seasonal pattern takes precedence in
diagnostic coding and is the central clue.
Q2. A 65-year-old female with no prior psychiatric history is
brought in by her daughter for a 4-month progressive decline.
She is apathetic, has significant psychomotor slowing, poor
hygiene, and blunt affect. She denies sadness or anhedonia.
Physical workup, including brain MRI and TSH, is normal. She
scores 28/30 on MMSE, missing points only on recall. What is
the most likely diagnosis?
A. Major Depressive Disorder
B. Alzheimer's Disease
C. Vascular Dementia
D. Depressive Disorder Due to Another Medical Condition
Correct Answer: A
Rationale: In older adults, depression can present with
prominent cognitive complaints ("pseudodementia") and a
predominance of psychomotor retardation/apathy rather than
overt sadness. The normal MMSE (recall loss is common in both
depression and dementia) and normal medical workup point to
a primary psychiatric etiology. The absence of a medical cause
rules out Option D.
Q3. A 19-year-old college student describes sudden,
overwhelming episodes of palpitations, chest pain, trembling,
and a fear of "going crazy" that peak within minutes. These
occur unexpectedly, at least once a week. She now avoids the
library and dining hall fearing an attack. What is the cornerstone
,diagnostic feature that differentiates this disorder from other
anxiety disorders?
A. The presence of anticipatory anxiety
B. The spontaneous, uncued nature of the panic attacks
C. The development of agoraphobic avoidance
D. The physical symptoms during the attack
Correct Answer: B
Rationale: While all options are features of Panic Disorder,
the spontaneous, uncued panic attack is the cornerstone.
Expected attacks in response to specific triggers are more
indicative of a specific phobia or social anxiety. The diagnosis
requires recurrent unexpected panic attacks followed by
persistent worry or behavioral change.
Q4. (Select All That Apply): A 42-year-old veteran with PTSD
from combat exposure presents for medication management.
Which of the following symptom clusters must be present to
meet DSM-5-TR criteria for PTSD? Select three.
A. Intrusive symptoms (e.g., memories, nightmares)
B. Persistent avoidance of stimuli associated with the trauma
C. Negative alterations in cognition and mood
D. Marked alterations in arousal and reactivity
E. Depersonalization or derealization
Correct Answer: A, B, C, D
Rationale: DSM-5-TR requires symptoms from all four clusters
(A-D) for a PTSD diagnosis. Cluster A (intrusion), B (avoidance),
C (negative cognitions/mood), and D (arousal).
, Depersonalization/derealization (E) is part of the dissociative
specifier, not a required criterion.
Q5. A 30-year-old man presents with a 2-week history of
grandiose delusions, decreased need for sleep, and pressured
speech. He was previously diagnosed with Schizoaffective
Disorder, Bipolar Type, 5 years ago and has had two similar
episodes requiring hospitalization. Between episodes, for the
past 18 months, he has had ongoing auditory commentary and
social withdrawal without prominent mood symptoms, despite
treatment. What is the most accurate diagnosis?
A. Bipolar I Disorder with psychotic features
B. Schizophrenia
C. Schizoaffective Disorder, Bipolar Type
D. Delusional Disorder
Correct Answer: C
Rationale: Schizoaffective Disorder requires: 1) A major mood
episode concurrent with active phase psychotic symptoms
(Criterion A). 2) Delusions or hallucinations for two or more
weeks in the absence of a major mood episode during the
illness's lifetime (Criterion B). This history describes psychotic
symptoms persisting between mood episodes, fulfilling
Criterion B and differentiating it from Bipolar I with psychotic
features.
Q6. A 78-year-old man with hypertension presents with a
stepwise decline in function. His cognitive deficits are "patchy" -
severe executive dysfunction and gait apraxia, but relatively
