NR547 FINAL EXAM LATEST 2026/2027 | Differential
Diagnosis Psychiatric-Mental Health Across Lifespan |
Practicum Exam Review Guide | Pass Guaranteed - A+
Graded
Section 1: Differential Diagnosis Foundations & Clinical
Reasoning (Questions 1-12)
Question 1
A 45-year-old patient presents with new-onset anxiety, tremor, weight loss, and heat
intolerance. Before assigning a primary anxiety disorder diagnosis, the PMHNP should
FIRST:
A. Initiate an SSRI for generalized anxiety disorder
B. Order thyroid function tests (TSH, free T4) to rule out hyperthyroidism
C. Begin cognitive-behavioral therapy
D. Prescribe a benzodiazepine for symptom relief
Correct Answer: B. Order thyroid function tests (TSH, free T4) to rule out
hyperthyroidism [CORRECT]
Rationale: The differential diagnosis hierarchy requires ruling out medical etiologies
before assigning primary mental disorder diagnoses. Hyperthyroidism mimics anxiety
disorders with tremor, weight loss, heat intolerance, and anxiety. Initiating
psychotropic treatment (Options A, D) or psychotherapy (Option C) without medical
workup risks missing a treatable organic cause. NR547 emphasizes that medical rule-
out is the foundational first step in differential diagnosis.
Question 2
A patient presents with psychotic symptoms (auditory hallucinations, paranoid
delusions) and reports heavy daily cannabis use for the past 2 months. According to
DSM-5-TR differential diagnosis steps, the FIRST consideration should be:
,A. Schizophrenia
B. Cannabis-induced psychotic disorder
C. Bipolar I disorder with psychotic features
D. Delusional disorder
Correct Answer: B. Cannabis-induced psychotic disorder [CORRECT]
Rationale: DSM-5-TR requires ruling out substance etiology before assigning primary
psychotic disorder diagnoses. Heavy cannabis use, particularly high-potency products,
can cause psychosis that resolves with abstinence. Schizophrenia (Option A), bipolar
disorder (Option C), and delusional disorder (Option D) are primary diagnoses that
should only be considered after substance-induced psychosis is ruled out. NR547
emphasizes the hierarchy: substance → medical → primary mental disorder.
Question 3
The Cultural Formulation Interview (CFI) is used in psychiatric assessment to:
A. Diagnose culture-bound syndromes only
B. Assess how cultural factors affect the patient's experience, expression, and
explanation of symptoms, as well as treatment preferences
C. Replace the standard psychiatric interview
D. Determine the patient's immigration status
Correct Answer: B. Assess how cultural factors affect the patient's experience,
expression, and explanation of symptoms, as well as treatment preferences
[CORRECT]
Rationale: The CFI systematically explores cultural identity, conceptualizations of
distress, psychosocial stressors, features of vulnerability and resilience, and the
clinician-patient relationship. It does not replace standard assessment (Option C),
diagnose only culture-bound syndromes (Option A), or assess immigration status
(Option D). NR547 emphasizes that cultural formulation prevents misdiagnosis and
improves engagement.
,Question 4
A patient is found to be intentionally exaggerating psychiatric symptoms to obtain
disability benefits. This presentation is MOST consistent with:
A. Factitious disorder
B. Malingering
C. Somatic symptom disorder
D. Conversion disorder
Correct Answer: B. Malingering [CORRECT]
Rationale: Malingering involves intentional production of symptoms for external
incentives (disability, legal, financial gain). Factitious disorder (Option A) involves
intentional symptom production for psychological gain (sick role) without external
incentive. Somatic symptom disorder (Option C) and conversion disorder (Option D)
involve genuine distress without conscious symptom production. NR547 emphasizes
that malingering must be ruled out early in the differential hierarchy.
Question 5
A patient presents with depression and is found to have a TSH of 12.5 mIU/L (elevated)
and free T4 of 0.7 ng/dL (low). The depression is MOST likely:
A. Primary major depressive disorder
B. Depressive disorder due to another medical condition (hypothyroidism)
C. Adjustment disorder with depressed mood
D. Persistent depressive disorder
Correct Answer: B. Depressive disorder due to another medical condition
(hypothyroidism) [CORRECT]
Rationale: Hypothyroidism (elevated TSH, low free T4) is a well-established cause of
depressive symptoms. The diagnosis is depressive disorder due to another medical
condition when the medical condition is etiologically related to the depression. Primary
MDD (Option A), adjustment disorder (Option C), and PDD (Option D) are inappropriate
when a clear medical etiology exists. NR547 emphasizes that treating the underlying
medical condition often resolves associated psychiatric symptoms.
, Question 6
A patient on prednisone 40 mg daily for lupus develops euphoria, decreased need for
sleep, pressured speech, and grandiosity. The MOST likely diagnosis is:
A. Bipolar I disorder, current episode manic
B. Substance/medication-induced bipolar and related disorder
C. Schizophrenia
D. Narcissistic personality disorder
Correct Answer: B. Substance/medication-induced bipolar and related disorder
[CORRECT]
Rationale: Corticosteroids (prednisone) are well-documented causes of manic-like
symptoms. The temporal relationship to medication initiation and absence of prior
mood episodes support a substance/medication-induced etiology. Bipolar I (Option A)
requires ruling out substances/medications. Schizophrenia (Option C) and narcissistic
PD (Option D) do not fit the presentation. NR547 emphasizes that medication-induced
mood symptoms are common and reversible.
Question 7
A patient presents with cognitive decline, memory impairment, and personality
changes. MRI shows multiple white matter hyperintensities and lacunar infarcts. The
MOST likely diagnosis is:
A. Alzheimer's disease
B. Major neurocognitive disorder due to vascular disease
C. Frontotemporal dementia
D. Creutzfeldt-Jakob disease
Correct Answer: B. Major neurocognitive disorder due to vascular disease
[CORRECT]
Rationale: Vascular neurocognitive disorder presents with stepwise decline, focal
neurological signs, and imaging evidence of cerebrovascular disease (white matter
Diagnosis Psychiatric-Mental Health Across Lifespan |
Practicum Exam Review Guide | Pass Guaranteed - A+
Graded
Section 1: Differential Diagnosis Foundations & Clinical
Reasoning (Questions 1-12)
Question 1
A 45-year-old patient presents with new-onset anxiety, tremor, weight loss, and heat
intolerance. Before assigning a primary anxiety disorder diagnosis, the PMHNP should
FIRST:
A. Initiate an SSRI for generalized anxiety disorder
B. Order thyroid function tests (TSH, free T4) to rule out hyperthyroidism
C. Begin cognitive-behavioral therapy
D. Prescribe a benzodiazepine for symptom relief
Correct Answer: B. Order thyroid function tests (TSH, free T4) to rule out
hyperthyroidism [CORRECT]
Rationale: The differential diagnosis hierarchy requires ruling out medical etiologies
before assigning primary mental disorder diagnoses. Hyperthyroidism mimics anxiety
disorders with tremor, weight loss, heat intolerance, and anxiety. Initiating
psychotropic treatment (Options A, D) or psychotherapy (Option C) without medical
workup risks missing a treatable organic cause. NR547 emphasizes that medical rule-
out is the foundational first step in differential diagnosis.
Question 2
A patient presents with psychotic symptoms (auditory hallucinations, paranoid
delusions) and reports heavy daily cannabis use for the past 2 months. According to
DSM-5-TR differential diagnosis steps, the FIRST consideration should be:
,A. Schizophrenia
B. Cannabis-induced psychotic disorder
C. Bipolar I disorder with psychotic features
D. Delusional disorder
Correct Answer: B. Cannabis-induced psychotic disorder [CORRECT]
Rationale: DSM-5-TR requires ruling out substance etiology before assigning primary
psychotic disorder diagnoses. Heavy cannabis use, particularly high-potency products,
can cause psychosis that resolves with abstinence. Schizophrenia (Option A), bipolar
disorder (Option C), and delusional disorder (Option D) are primary diagnoses that
should only be considered after substance-induced psychosis is ruled out. NR547
emphasizes the hierarchy: substance → medical → primary mental disorder.
Question 3
The Cultural Formulation Interview (CFI) is used in psychiatric assessment to:
A. Diagnose culture-bound syndromes only
B. Assess how cultural factors affect the patient's experience, expression, and
explanation of symptoms, as well as treatment preferences
C. Replace the standard psychiatric interview
D. Determine the patient's immigration status
Correct Answer: B. Assess how cultural factors affect the patient's experience,
expression, and explanation of symptoms, as well as treatment preferences
[CORRECT]
Rationale: The CFI systematically explores cultural identity, conceptualizations of
distress, psychosocial stressors, features of vulnerability and resilience, and the
clinician-patient relationship. It does not replace standard assessment (Option C),
diagnose only culture-bound syndromes (Option A), or assess immigration status
(Option D). NR547 emphasizes that cultural formulation prevents misdiagnosis and
improves engagement.
,Question 4
A patient is found to be intentionally exaggerating psychiatric symptoms to obtain
disability benefits. This presentation is MOST consistent with:
A. Factitious disorder
B. Malingering
C. Somatic symptom disorder
D. Conversion disorder
Correct Answer: B. Malingering [CORRECT]
Rationale: Malingering involves intentional production of symptoms for external
incentives (disability, legal, financial gain). Factitious disorder (Option A) involves
intentional symptom production for psychological gain (sick role) without external
incentive. Somatic symptom disorder (Option C) and conversion disorder (Option D)
involve genuine distress without conscious symptom production. NR547 emphasizes
that malingering must be ruled out early in the differential hierarchy.
Question 5
A patient presents with depression and is found to have a TSH of 12.5 mIU/L (elevated)
and free T4 of 0.7 ng/dL (low). The depression is MOST likely:
A. Primary major depressive disorder
B. Depressive disorder due to another medical condition (hypothyroidism)
C. Adjustment disorder with depressed mood
D. Persistent depressive disorder
Correct Answer: B. Depressive disorder due to another medical condition
(hypothyroidism) [CORRECT]
Rationale: Hypothyroidism (elevated TSH, low free T4) is a well-established cause of
depressive symptoms. The diagnosis is depressive disorder due to another medical
condition when the medical condition is etiologically related to the depression. Primary
MDD (Option A), adjustment disorder (Option C), and PDD (Option D) are inappropriate
when a clear medical etiology exists. NR547 emphasizes that treating the underlying
medical condition often resolves associated psychiatric symptoms.
, Question 6
A patient on prednisone 40 mg daily for lupus develops euphoria, decreased need for
sleep, pressured speech, and grandiosity. The MOST likely diagnosis is:
A. Bipolar I disorder, current episode manic
B. Substance/medication-induced bipolar and related disorder
C. Schizophrenia
D. Narcissistic personality disorder
Correct Answer: B. Substance/medication-induced bipolar and related disorder
[CORRECT]
Rationale: Corticosteroids (prednisone) are well-documented causes of manic-like
symptoms. The temporal relationship to medication initiation and absence of prior
mood episodes support a substance/medication-induced etiology. Bipolar I (Option A)
requires ruling out substances/medications. Schizophrenia (Option C) and narcissistic
PD (Option D) do not fit the presentation. NR547 emphasizes that medication-induced
mood symptoms are common and reversible.
Question 7
A patient presents with cognitive decline, memory impairment, and personality
changes. MRI shows multiple white matter hyperintensities and lacunar infarcts. The
MOST likely diagnosis is:
A. Alzheimer's disease
B. Major neurocognitive disorder due to vascular disease
C. Frontotemporal dementia
D. Creutzfeldt-Jakob disease
Correct Answer: B. Major neurocognitive disorder due to vascular disease
[CORRECT]
Rationale: Vascular neurocognitive disorder presents with stepwise decline, focal
neurological signs, and imaging evidence of cerebrovascular disease (white matter
