NEWEST NR WEEK 4 MIDTERM DIFFERENTIAL DIAGNOSIS IN
PSYCHIATRIC MENTAL HEALTH ACROSS THE LIFE SPAN (MSN-
PMHNP) ACTUAL EXAM 2026/2027 PRACTICE QUESTIONS AND
STUDY GUIDE COMPLETE ACCURATE EXAM APPROVED
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH DETAILED
RATIONALES (A NEW UPDATED VERSION 2026 EDITION)
|GUARANTEED SUCCESS A+ |FULL REVISED
Question 1
A 32-year-old male presents with a 6-month history of depressed mood, anhedonia,
insomnia, and poor appetite. He reports no history of mania or hypomania. Which
of the following is the most appropriate initial diagnosis?
A) Major depressive disorder, single episode
B) Persistent depressive disorder (dysthymia)
C) Adjustment disorder with depressed mood
D) Bipolar II disorder, current episode depressed
Correct Answer: A) Major depressive disorder, single episode
*Rationale: The patient meets DSM-5-TR criteria for a major depressive episode
(duration >2 weeks, core symptoms of depressed mood and anhedonia, plus
neurovegetative symptoms). No history of mania/hypomania rules out bipolar
spectrum disorders. Persistent depressive disorder requires symptoms for at least 2
years. Adjustment disorder would require an identifiable stressor within 3 months.
*
Question 2
A 16-year-old female has had two distinct episodes of elevated mood, decreased
need for sleep, increased goal-directed activity, and grandiosity, each lasting 5
,days. She has no depressive episodes. What is the most likely diagnosis?
A) Bipolar I disorder
B) Bipolar II disorder
C) Cyclothymic disorder
D) Other specified bipolar and related disorder
Correct Answer: D) Other specified bipolar and related disorder
*Rationale: Hypomanic episodes must last at least 4 consecutive days for Bipolar
II, but here episodes are 5 days (meeting duration) but no depressive episodes.
Bipolar I require a manic episode (≥7 days or hospitalization). Cyclothymic
requires numerous hypomanic and depressive symptoms for ≥2 years. Given
absence of depressive episodes, the best fit is other specified bipolar disorder
(short-duration hypomanic episodes without depression). *
Question 3
A 45-year-old male reports feeling “on edge” for the past 8 months, with muscle
tension, fatigue, and difficulty concentrating. He worries excessively about his job,
finances, and health. What is the most appropriate diagnosis?
A) Panic disorder
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Obsessive-compulsive disorder
Correct Answer: B) Generalized anxiety disorder
*Rationale: Symptoms of excessive anxiety and worry occurring more days than
not for ≥6 months, associated with ≥3 of: restlessness, fatigue, difficulty
,concentrating, irritability, muscle tension, sleep disturbance. Panic disorder
requires recurrent unexpected panic attacks. Social anxiety involves fear of
scrutiny. OCD involves obsessions/compulsions. *
Question 4
A 72-year-old male with no prior psychiatric history develops a major depressive
episode 2 months after starting propranolol for hypertension. The most appropriate
next step is:
A) Add fluoxetine
B) Increase propranolol dose
C) Discontinue propranolol and switch to another antihypertensive
D) Start quetiapine
Correct Answer: C) Discontinue propranolol and switch to another
antihypertensive
Rationale: Beta-blockers (e.g., propranolol) can cause medication-induced
depressive disorder. The first-line intervention is to remove the offending agent if
clinically feasible. Adding an antidepressant without addressing the cause is not
optimal; increasing propranolol would worsen symptoms. Quetiapine is not first
line for medication-induced depression.
Question 5
A 28-year-old female reports recurrent episodes of palpitations, sweating,
trembling, and fear of dying, peaking within 10 minutes. Between episodes, she is
completely asymptomatic. What is the most likely diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
, C) Agoraphobia
D) Specific phobia
Correct Answer: B) Panic disorder
*Rationale: Recurrent unexpected panic attacks (defined by abrupt surge of intense
fear with ≥4 somatic/cognitive symptoms) followed by ≥1 month of worry about
additional attacks or maladaptive behavior change. GAD involves chronic worry,
not discrete attacks. Agoraphobia often co-occurs but requires fear of situations
where escape is difficult. *
Question 6
A 19-year-old college student reports feeling sad, losing interest in activities,
sleeping 12 hours per day, and eating excessively for the past 3 weeks. She denies
suicidal ideation. What specifier would you add to her major depressive disorder
diagnosis?
A) With mixed features
B) With atypical features
C) With melancholic features
D) With per partum onset
Correct Answer: B) With atypical features
*Rationale: Atypical features in MDD include mood reactivity (not required here
but implied), plus ≥2 of: increased appetite/weight gain, hypersomnia, leaden
paralysis, and long-standing interpersonal rejection sensitivity. Hypersomnia and
increased eating fit this specifier. Melancholic features include early morning
awakening and anorexia. Mixed features require hypomanic symptoms. *
Question 7
PSYCHIATRIC MENTAL HEALTH ACROSS THE LIFE SPAN (MSN-
PMHNP) ACTUAL EXAM 2026/2027 PRACTICE QUESTIONS AND
STUDY GUIDE COMPLETE ACCURATE EXAM APPROVED
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH DETAILED
RATIONALES (A NEW UPDATED VERSION 2026 EDITION)
|GUARANTEED SUCCESS A+ |FULL REVISED
Question 1
A 32-year-old male presents with a 6-month history of depressed mood, anhedonia,
insomnia, and poor appetite. He reports no history of mania or hypomania. Which
of the following is the most appropriate initial diagnosis?
A) Major depressive disorder, single episode
B) Persistent depressive disorder (dysthymia)
C) Adjustment disorder with depressed mood
D) Bipolar II disorder, current episode depressed
Correct Answer: A) Major depressive disorder, single episode
*Rationale: The patient meets DSM-5-TR criteria for a major depressive episode
(duration >2 weeks, core symptoms of depressed mood and anhedonia, plus
neurovegetative symptoms). No history of mania/hypomania rules out bipolar
spectrum disorders. Persistent depressive disorder requires symptoms for at least 2
years. Adjustment disorder would require an identifiable stressor within 3 months.
*
Question 2
A 16-year-old female has had two distinct episodes of elevated mood, decreased
need for sleep, increased goal-directed activity, and grandiosity, each lasting 5
,days. She has no depressive episodes. What is the most likely diagnosis?
A) Bipolar I disorder
B) Bipolar II disorder
C) Cyclothymic disorder
D) Other specified bipolar and related disorder
Correct Answer: D) Other specified bipolar and related disorder
*Rationale: Hypomanic episodes must last at least 4 consecutive days for Bipolar
II, but here episodes are 5 days (meeting duration) but no depressive episodes.
Bipolar I require a manic episode (≥7 days or hospitalization). Cyclothymic
requires numerous hypomanic and depressive symptoms for ≥2 years. Given
absence of depressive episodes, the best fit is other specified bipolar disorder
(short-duration hypomanic episodes without depression). *
Question 3
A 45-year-old male reports feeling “on edge” for the past 8 months, with muscle
tension, fatigue, and difficulty concentrating. He worries excessively about his job,
finances, and health. What is the most appropriate diagnosis?
A) Panic disorder
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Obsessive-compulsive disorder
Correct Answer: B) Generalized anxiety disorder
*Rationale: Symptoms of excessive anxiety and worry occurring more days than
not for ≥6 months, associated with ≥3 of: restlessness, fatigue, difficulty
,concentrating, irritability, muscle tension, sleep disturbance. Panic disorder
requires recurrent unexpected panic attacks. Social anxiety involves fear of
scrutiny. OCD involves obsessions/compulsions. *
Question 4
A 72-year-old male with no prior psychiatric history develops a major depressive
episode 2 months after starting propranolol for hypertension. The most appropriate
next step is:
A) Add fluoxetine
B) Increase propranolol dose
C) Discontinue propranolol and switch to another antihypertensive
D) Start quetiapine
Correct Answer: C) Discontinue propranolol and switch to another
antihypertensive
Rationale: Beta-blockers (e.g., propranolol) can cause medication-induced
depressive disorder. The first-line intervention is to remove the offending agent if
clinically feasible. Adding an antidepressant without addressing the cause is not
optimal; increasing propranolol would worsen symptoms. Quetiapine is not first
line for medication-induced depression.
Question 5
A 28-year-old female reports recurrent episodes of palpitations, sweating,
trembling, and fear of dying, peaking within 10 minutes. Between episodes, she is
completely asymptomatic. What is the most likely diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
, C) Agoraphobia
D) Specific phobia
Correct Answer: B) Panic disorder
*Rationale: Recurrent unexpected panic attacks (defined by abrupt surge of intense
fear with ≥4 somatic/cognitive symptoms) followed by ≥1 month of worry about
additional attacks or maladaptive behavior change. GAD involves chronic worry,
not discrete attacks. Agoraphobia often co-occurs but requires fear of situations
where escape is difficult. *
Question 6
A 19-year-old college student reports feeling sad, losing interest in activities,
sleeping 12 hours per day, and eating excessively for the past 3 weeks. She denies
suicidal ideation. What specifier would you add to her major depressive disorder
diagnosis?
A) With mixed features
B) With atypical features
C) With melancholic features
D) With per partum onset
Correct Answer: B) With atypical features
*Rationale: Atypical features in MDD include mood reactivity (not required here
but implied), plus ≥2 of: increased appetite/weight gain, hypersomnia, leaden
paralysis, and long-standing interpersonal rejection sensitivity. Hypersomnia and
increased eating fit this specifier. Melancholic features include early morning
awakening and anorexia. Mixed features require hypomanic symptoms. *
Question 7
