NR547 MIDTERM EXAM LATEST 2026/2027 | Differential
Diagnosis Psychiatric-Mental Health Across Lifespan |
Practicum Exam Review | Complete Guide with Verified
Answers | Chamberlain | Pass Guaranteed - A+ Graded
Section 1: Differential Diagnosis Foundations & Clinical
Reasoning Process (Questions 1-12)
Q1. A 34-year-old patient presents with symptoms of depression, anxiety, and
fatigue. The PMHNP is conducting the initial differential diagnosis workup. According
to the DSM-5-TR differential diagnosis steps, which of the following should be the
FIRST step in the diagnostic process?
A. Determine the primary mental disorder based on symptom clusters
B. Rule out substance/medication-induced disorders
C. Rule out malingering and factitious disorder
D. Rule out medical conditions that may explain the symptoms
C. Rule out malingering and factitious disorder [CORRECT]
Rationale: The DSM-5-TR hierarchical approach to differential diagnosis begins with
ruling out malingering (external incentive present) and factitious disorder (no
external incentive, desire to assume sick role) before proceeding to substance-
induced, medical, and primary mental disorder considerations. This ensures that
intentional symptom production or secondary gain is addressed first.
Correct Answer: C
Q2. A patient is seeking disability benefits and reports severe, disabling psychiatric
symptoms that are inconsistent with observed behavior and collateral information.
,The patient has an external incentive. Which differential diagnosis should be ruled
out first?
A. Factitious disorder
B. Somatic symptom disorder
C. Malingering
D. Conversion disorder
C. Malingering [CORRECT]
Rationale: Malingering is characterized by the intentional production of false or
exaggerated symptoms motivated by external incentives such as financial
compensation, avoiding work, obtaining drugs, or avoiding legal consequences.
Unlike factitious disorder, there is no desire to assume the sick role for its own sake.
The presence of clear external incentive makes malingering the primary
consideration.
Correct Answer: C
Q3. A 28-year-old woman has been hospitalized 12 times in the past two years for
unexplained seizures and gastrointestinal bleeding. Extensive medical workups are
negative. She appears to enjoy the attention and care received during
hospitalizations, and there is no evidence of external gain. Which diagnosis should be
considered?
A. Malingering
B. Factitious disorder
C. Somatic symptom disorder
D. Illness anxiety disorder
B. Factitious disorder [CORRECT]
Rationale: Factitious disorder involves the intentional falsification of physical or
psychological signs or symptoms, or induction of injury or disease, with the
individual presenting himself or herself as ill or injured, but without external rewards.
The desire to assume the sick role distinguishes it from malingering. This patient's
,repeated hospitalizations, negative workups, and apparent enjoyment of the patient
role without external incentive are classic for factitious disorder.
Correct Answer: B
Q4. A 45-year-old man presents with new-onset anxiety, tremors, and insomnia. He
recently started taking prednisone 60mg daily for an autoimmune condition.
According to DSM-5-TR differential diagnosis hierarchy, which step is most
appropriate?
A. Determine the primary anxiety disorder
B. Rule out substance/medication-induced disorder
C. Rule out medical condition
D. Rule out malingering
B. Rule out substance/medication-induced disorder [CORRECT]
Rationale: After ruling out malingering and factitious disorder, the next step in the
DSM-5-TR differential diagnosis hierarchy is to rule out substance/medication-
induced disorders. Prednisone is a corticosteroid known to cause anxiety, insomnia,
and tremors. The temporal relationship between medication initiation and symptom
onset strongly suggests a substance/medication-induced condition.
Correct Answer: B
Q5. A 52-year-old woman presents with depressive symptoms, fatigue, weight gain,
and cold intolerance. Laboratory studies reveal elevated TSH and low free T4. Which
differential diagnosis principle applies?
A. Determine primary major depressive disorder
B. Rule out medical condition before diagnosing primary mental disorder
C. Rule out substance-induced disorder first
D. Diagnose adjustment disorder with depressed mood
, B. Rule out medical condition before diagnosing primary mental disorder
[CORRECT]
Rationale: The DSM-5-TR differential diagnosis hierarchy requires ruling out medical
conditions that may explain psychiatric symptoms before assigning a primary mental
disorder diagnosis. Hypothyroidism commonly presents with depressive symptoms,
fatigue, weight gain, and cold intolerance. Treating the underlying thyroid
dysfunction may resolve the psychiatric symptoms, making this a critical rule-out
step.
Correct Answer: B
Q6. During the Cultural Formulation Interview (CFI), a PMHNP asks a patient: "For
you, what are the most important aspects of your background or identity?" This
question addresses which domain of the CFI?
A. Cultural identity of the individual
B. Psychosocial stressors and cultural features of vulnerability and resilience
C. Cultural features of the clinician-patient relationship
D. Overall cultural assessment
A. Cultural identity of the individual [CORRECT]
Rationale: The Cultural Formulation Interview (CFI) is a 16-question semi-structured
interview that systematically assesses cultural factors in psychiatric evaluation.
Questions about background, identity, and cultural group membership address
Domain 1: Cultural Identity of the Individual. This domain explores race, ethnicity,
language, religion, socioeconomic status, and other cultural affiliations that shape
the patient's experience.
Correct Answer: A
Diagnosis Psychiatric-Mental Health Across Lifespan |
Practicum Exam Review | Complete Guide with Verified
Answers | Chamberlain | Pass Guaranteed - A+ Graded
Section 1: Differential Diagnosis Foundations & Clinical
Reasoning Process (Questions 1-12)
Q1. A 34-year-old patient presents with symptoms of depression, anxiety, and
fatigue. The PMHNP is conducting the initial differential diagnosis workup. According
to the DSM-5-TR differential diagnosis steps, which of the following should be the
FIRST step in the diagnostic process?
A. Determine the primary mental disorder based on symptom clusters
B. Rule out substance/medication-induced disorders
C. Rule out malingering and factitious disorder
D. Rule out medical conditions that may explain the symptoms
C. Rule out malingering and factitious disorder [CORRECT]
Rationale: The DSM-5-TR hierarchical approach to differential diagnosis begins with
ruling out malingering (external incentive present) and factitious disorder (no
external incentive, desire to assume sick role) before proceeding to substance-
induced, medical, and primary mental disorder considerations. This ensures that
intentional symptom production or secondary gain is addressed first.
Correct Answer: C
Q2. A patient is seeking disability benefits and reports severe, disabling psychiatric
symptoms that are inconsistent with observed behavior and collateral information.
,The patient has an external incentive. Which differential diagnosis should be ruled
out first?
A. Factitious disorder
B. Somatic symptom disorder
C. Malingering
D. Conversion disorder
C. Malingering [CORRECT]
Rationale: Malingering is characterized by the intentional production of false or
exaggerated symptoms motivated by external incentives such as financial
compensation, avoiding work, obtaining drugs, or avoiding legal consequences.
Unlike factitious disorder, there is no desire to assume the sick role for its own sake.
The presence of clear external incentive makes malingering the primary
consideration.
Correct Answer: C
Q3. A 28-year-old woman has been hospitalized 12 times in the past two years for
unexplained seizures and gastrointestinal bleeding. Extensive medical workups are
negative. She appears to enjoy the attention and care received during
hospitalizations, and there is no evidence of external gain. Which diagnosis should be
considered?
A. Malingering
B. Factitious disorder
C. Somatic symptom disorder
D. Illness anxiety disorder
B. Factitious disorder [CORRECT]
Rationale: Factitious disorder involves the intentional falsification of physical or
psychological signs or symptoms, or induction of injury or disease, with the
individual presenting himself or herself as ill or injured, but without external rewards.
The desire to assume the sick role distinguishes it from malingering. This patient's
,repeated hospitalizations, negative workups, and apparent enjoyment of the patient
role without external incentive are classic for factitious disorder.
Correct Answer: B
Q4. A 45-year-old man presents with new-onset anxiety, tremors, and insomnia. He
recently started taking prednisone 60mg daily for an autoimmune condition.
According to DSM-5-TR differential diagnosis hierarchy, which step is most
appropriate?
A. Determine the primary anxiety disorder
B. Rule out substance/medication-induced disorder
C. Rule out medical condition
D. Rule out malingering
B. Rule out substance/medication-induced disorder [CORRECT]
Rationale: After ruling out malingering and factitious disorder, the next step in the
DSM-5-TR differential diagnosis hierarchy is to rule out substance/medication-
induced disorders. Prednisone is a corticosteroid known to cause anxiety, insomnia,
and tremors. The temporal relationship between medication initiation and symptom
onset strongly suggests a substance/medication-induced condition.
Correct Answer: B
Q5. A 52-year-old woman presents with depressive symptoms, fatigue, weight gain,
and cold intolerance. Laboratory studies reveal elevated TSH and low free T4. Which
differential diagnosis principle applies?
A. Determine primary major depressive disorder
B. Rule out medical condition before diagnosing primary mental disorder
C. Rule out substance-induced disorder first
D. Diagnose adjustment disorder with depressed mood
, B. Rule out medical condition before diagnosing primary mental disorder
[CORRECT]
Rationale: The DSM-5-TR differential diagnosis hierarchy requires ruling out medical
conditions that may explain psychiatric symptoms before assigning a primary mental
disorder diagnosis. Hypothyroidism commonly presents with depressive symptoms,
fatigue, weight gain, and cold intolerance. Treating the underlying thyroid
dysfunction may resolve the psychiatric symptoms, making this a critical rule-out
step.
Correct Answer: B
Q6. During the Cultural Formulation Interview (CFI), a PMHNP asks a patient: "For
you, what are the most important aspects of your background or identity?" This
question addresses which domain of the CFI?
A. Cultural identity of the individual
B. Psychosocial stressors and cultural features of vulnerability and resilience
C. Cultural features of the clinician-patient relationship
D. Overall cultural assessment
A. Cultural identity of the individual [CORRECT]
Rationale: The Cultural Formulation Interview (CFI) is a 16-question semi-structured
interview that systematically assesses cultural factors in psychiatric evaluation.
Questions about background, identity, and cultural group membership address
Domain 1: Cultural Identity of the Individual. This domain explores race, ethnicity,
language, religion, socioeconomic status, and other cultural affiliations that shape
the patient's experience.
Correct Answer: A
