NR 547 Differential Diagnosis Final Exam
2025/2026 | Chamberlain College of Nursing
PMHNP Practicum | 50 Question & Answer
Practice Test | Verified Rationales & DSM-5-TR
Guide
Q1. A 28-year-old female presents with a 3-month history of
persistent, pervasive low mood, anhedonia, significant weight
loss, and insomnia with early morning awakening. She reports
frequent, intrusive thoughts that she is "a burden" and that her
family would be "better off" without her, but she has no specific
plan. She describes her mood as consistently "empty." During
the assessment, her speech is slow, and she shows minimal
facial expression. She denies any history of manic or hypomanic
episodes. Her symptoms began shortly after she was passed
over for a promotion. What is the most accurate initial
diagnosis?
,A. Adjustment Disorder with Depressed Mood
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder, Single Episode, Severe without
psychotic features
D. Bipolar II Disorder, Current Episode Depressed
Correct Answer: C
Rationale: The presentation meets DSM-5-TR criteria for a
Major Depressive Episode (depressed mood, anhedonia,
significant weight change, sleep disturbance, psychomotor
retardation, feelings of worthlessness, and suicidal ideation)
lasting longer than 2 weeks. The severity is marked by the
number of symptoms, significant functional impairment, and
passive suicidal ideation. Adjustment Disorder (A) is ruled out
by the severity, number, and duration of symptoms exceeding
what would be expected. Persistent Depressive Disorder (B)
requires a depressed mood for most of the day, for more days
than not, for at least 2 years. Bipolar II (D) requires a history of
at least one hypomanic episode, which is denied.
Q2. A 16-year-old male is brought by his parents due to
increasing social withdrawal and declining grades over the past
8 months. He spends all his time in his room playing online
games. He reports he feels "misunderstood" and that his
classmates are "superficial." On interview, he is guarded but
cooperative. He describes a constant, vague feeling that people
might be talking about him but admits this is probably just his
insecurity. He reports low mood and insomnia but attributes it
,to "stress." He denies hallucinations, formal thought disorder,
or a history of manic symptoms. The most appropriate
provisional diagnosis is:
A. Schizotypal Personality Disorder
B. Major Depressive Disorder with Psychotic Features
C. Schizophrenia, Prodromal Phase
D. Social Anxiety Disorder
Correct Answer: C
Rationale: This vignette describes attenuated psychosis
syndrome, often seen in the prodromal phase of schizophrenia.
Key features include social withdrawal, functional decline, and
attenuated positive symptoms (e.g., vague, referential thinking
without full delusional conviction) in an adolescent. Schizotypal
PD (A) is a pervasive, stable pattern from early adulthood, not
an 8-month decline. MDD with Psychotic Features (B) would
require a full major depressive episode and mood-congruent
psychotic symptoms. Social Anxiety Disorder (D) does not
explain the referential thinking or the degree of functional
decline and withdrawal.
Q3. A 45-year-old woman presents with a 6-month history of
fatigue, widespread muscle pain, and cognitive "fog." She has
visited multiple specialists, and all organic workups
(rheumatologic, endocrine, neurological) have been negative.
She is intensely focused on her symptoms and has quit her job
due to disability. She becomes tearful and angry when asked
about stress or psychological factors, stating, "This is not in my
, head. You doctors just don't believe me." The most likely
diagnosis is:
A. Illness Anxiety Disorder
B. Conversion Disorder (Functional Neurological Symptom
Disorder)
C. Somatic Symptom Disorder
D. Factitious Disorder
Correct Answer: C
Rationale: Somatic Symptom Disorder is characterized by one
or more distressing somatic symptoms that disrupt daily life,
accompanied by excessive thoughts, feelings, and behaviors
related to the health concerns. The negative workups, high level
of health-related anxiety, and significant functional impairment
align with SSD. Illness Anxiety Disorder (A) is preoccupation
with having a serious illness in the absence of somatic
symptoms (or with only mild symptoms). Conversion Disorder
(B) involves specific neurologic-like symptoms (e.g., paralysis,
seizures). Factitious Disorder (D) involves intentional feigning or
production of symptoms for the primary gain of assuming the
sick role.
Q4. (Select All That Apply) A 62-year-old man with a history of
hypertension and alcohol use disorder (in remission for 5 years)
presents with his wife for memory concerns. Over the past 2
years, he has shown progressive short-term memory loss,
getting lost in familiar places, and difficulty managing finances.
In the past 6 months, he has become suspicious, accusing his
2025/2026 | Chamberlain College of Nursing
PMHNP Practicum | 50 Question & Answer
Practice Test | Verified Rationales & DSM-5-TR
Guide
Q1. A 28-year-old female presents with a 3-month history of
persistent, pervasive low mood, anhedonia, significant weight
loss, and insomnia with early morning awakening. She reports
frequent, intrusive thoughts that she is "a burden" and that her
family would be "better off" without her, but she has no specific
plan. She describes her mood as consistently "empty." During
the assessment, her speech is slow, and she shows minimal
facial expression. She denies any history of manic or hypomanic
episodes. Her symptoms began shortly after she was passed
over for a promotion. What is the most accurate initial
diagnosis?
,A. Adjustment Disorder with Depressed Mood
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder, Single Episode, Severe without
psychotic features
D. Bipolar II Disorder, Current Episode Depressed
Correct Answer: C
Rationale: The presentation meets DSM-5-TR criteria for a
Major Depressive Episode (depressed mood, anhedonia,
significant weight change, sleep disturbance, psychomotor
retardation, feelings of worthlessness, and suicidal ideation)
lasting longer than 2 weeks. The severity is marked by the
number of symptoms, significant functional impairment, and
passive suicidal ideation. Adjustment Disorder (A) is ruled out
by the severity, number, and duration of symptoms exceeding
what would be expected. Persistent Depressive Disorder (B)
requires a depressed mood for most of the day, for more days
than not, for at least 2 years. Bipolar II (D) requires a history of
at least one hypomanic episode, which is denied.
Q2. A 16-year-old male is brought by his parents due to
increasing social withdrawal and declining grades over the past
8 months. He spends all his time in his room playing online
games. He reports he feels "misunderstood" and that his
classmates are "superficial." On interview, he is guarded but
cooperative. He describes a constant, vague feeling that people
might be talking about him but admits this is probably just his
insecurity. He reports low mood and insomnia but attributes it
,to "stress." He denies hallucinations, formal thought disorder,
or a history of manic symptoms. The most appropriate
provisional diagnosis is:
A. Schizotypal Personality Disorder
B. Major Depressive Disorder with Psychotic Features
C. Schizophrenia, Prodromal Phase
D. Social Anxiety Disorder
Correct Answer: C
Rationale: This vignette describes attenuated psychosis
syndrome, often seen in the prodromal phase of schizophrenia.
Key features include social withdrawal, functional decline, and
attenuated positive symptoms (e.g., vague, referential thinking
without full delusional conviction) in an adolescent. Schizotypal
PD (A) is a pervasive, stable pattern from early adulthood, not
an 8-month decline. MDD with Psychotic Features (B) would
require a full major depressive episode and mood-congruent
psychotic symptoms. Social Anxiety Disorder (D) does not
explain the referential thinking or the degree of functional
decline and withdrawal.
Q3. A 45-year-old woman presents with a 6-month history of
fatigue, widespread muscle pain, and cognitive "fog." She has
visited multiple specialists, and all organic workups
(rheumatologic, endocrine, neurological) have been negative.
She is intensely focused on her symptoms and has quit her job
due to disability. She becomes tearful and angry when asked
about stress or psychological factors, stating, "This is not in my
, head. You doctors just don't believe me." The most likely
diagnosis is:
A. Illness Anxiety Disorder
B. Conversion Disorder (Functional Neurological Symptom
Disorder)
C. Somatic Symptom Disorder
D. Factitious Disorder
Correct Answer: C
Rationale: Somatic Symptom Disorder is characterized by one
or more distressing somatic symptoms that disrupt daily life,
accompanied by excessive thoughts, feelings, and behaviors
related to the health concerns. The negative workups, high level
of health-related anxiety, and significant functional impairment
align with SSD. Illness Anxiety Disorder (A) is preoccupation
with having a serious illness in the absence of somatic
symptoms (or with only mild symptoms). Conversion Disorder
(B) involves specific neurologic-like symptoms (e.g., paralysis,
seizures). Factitious Disorder (D) involves intentional feigning or
production of symptoms for the primary gain of assuming the
sick role.
Q4. (Select All That Apply) A 62-year-old man with a history of
hypertension and alcohol use disorder (in remission for 5 years)
presents with his wife for memory concerns. Over the past 2
years, he has shown progressive short-term memory loss,
getting lost in familiar places, and difficulty managing finances.
In the past 6 months, he has become suspicious, accusing his
