NR547 Differential Diagnosis in Psychiatric-Mental Health
Across the Lifespan Practicum Midterm Exam Question
Bank (Latest 2026/2027 Edition) – Questions, Answers &
Detailed Rationales
──────────────────────────────
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSTIC FRAMEWORKS
──────────────────────────────
Question 1
A psychiatric-mental health nurse practitioner (PMHNP) is conducting an initial
evaluation of a 34-year-old patient. The patient reports mood swings, sleep
disturbances, and difficulty concentrating. Which assessment tool is most appropriate
to systematically evaluate the patient's current mental status and guide differential
diagnosis?
A. Beck Depression Inventory
B. Mini-Mental State Examination
C. Mental Status Examination
D. Hamilton Rating Scale for Anxiety
Correct Answer:
C — Mental Status Examination
Rationale:
The Mental Status Examination provides a comprehensive, structured assessment of
appearance, behavior, mood, affect, thought process, thought content, cognition, insight,
and judgment, forming the foundation for differential diagnosis. The Beck Depression
Inventory and Hamilton Anxiety Scale screen specific conditions; the MMSE assesses
cognitive impairment.
,Question 2
A PMHNP is formulating a differential diagnosis for a patient presenting with auditory
hallucinations and disorganized speech. Which framework is most essential for
distinguishing between schizophrenia, bipolar disorder with psychotic features, and
substance-induced psychotic disorder?
A. The biopsychosocial model only
B. The DSM-5-TR diagnostic criteria and rule-out methodology
C. The Maslow hierarchy of needs
D. The nursing process assessment phase only
Correct Answer:
B — The DSM-5-TR diagnostic criteria and rule-out methodology
Rationale:
The DSM-5-TR provides specific criteria, duration requirements, and exclusion rules
(e.g., substance-induced, medical condition) that are essential for differential diagnosis
of psychotic disorders. The biopsychosocial model informs understanding but does not
provide diagnostic specificity; Maslow's hierarchy is unrelated to differential diagnosis.
Question 3
A 19-year-old college student presents with sudden onset of paranoia, visual
hallucinations, and agitation after using a synthetic cannabinoid. The symptoms resolve
within 72 hours. Which diagnosis is most appropriate?
A. Schizophrenia
B. Brief psychotic disorder
C. Substance-induced psychotic disorder
D. Schizoaffective disorder
Correct Answer:
C — Substance-induced psychotic disorder
,Rationale:
Substance-induced psychotic disorder is diagnosed when psychotic symptoms are
attributable to substance use and resolve within a reasonable timeframe after
cessation. Schizophrenia requires 6 months of symptoms; brief psychotic disorder
occurs without substance use; schizoaffective disorder requires a mood episode
concurrent with psychosis.
Question 4
A PMHNP is evaluating a patient who reports depressed mood, anhedonia, fatigue, and
difficulty concentrating. The patient denies suicidal ideation but has a family history of
bipolar disorder. Which screening strategy is most critical before initiating
antidepressant therapy?
A. Administer a comprehensive metabolic panel
B. Screen for history of manic or hypomanic episodes
C. Order an electroencephalogram
D. Perform a lumbar puncture
Correct Answer:
B — Screen for history of manic or hypomanic episodes
Rationale:
Antidepressant monotherapy in bipolar disorder can precipitate manic episodes;
screening for past mania/hypomania is essential before initiating antidepressants. A
metabolic panel assesses general health; EEG and lumbar puncture are not indicated for
mood disorder evaluation.
Question 5
A patient presents with symptoms of depression, but the PMHNP notes that the patient
has been taking prednisone 40 mg daily for 3 weeks for an autoimmune condition.
Which diagnostic consideration is most appropriate?
, A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Depressive disorder due to another medical condition (corticosteroid-induced)
D. Persistent depressive disorder (dysthymia)
Correct Answer:
C — Depressive disorder due to another medical condition (corticosteroid-induced)
Rationale:
Corticosteroids are known to cause mood disturbances including depression and
mania; when symptoms are attributable to a medication or medical condition, the
appropriate diagnosis is depressive disorder due to another medical condition. Major
depressive disorder requires exclusion of substance/medical causes.
──────────────────────────────
SECTION 2: MOOD DISORDERS AND DIFFERENTIAL DIAGNOSIS
──────────────────────────────
Question 6
A 28-year-old patient reports episodes of elevated mood, decreased need for sleep,
increased goal-directed activity, and impulsive spending lasting 4 days, interspersed
with periods of normal mood. Which diagnosis is most appropriate?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder with seasonal pattern
Correct Answer:
B — Bipolar II disorder
Rationale:
Bipolar II disorder is characterized by at least one hypomanic episode (4+ days, not
causing severe impairment) and at least one major depressive episode. Bipolar I
Across the Lifespan Practicum Midterm Exam Question
Bank (Latest 2026/2027 Edition) – Questions, Answers &
Detailed Rationales
──────────────────────────────
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSTIC FRAMEWORKS
──────────────────────────────
Question 1
A psychiatric-mental health nurse practitioner (PMHNP) is conducting an initial
evaluation of a 34-year-old patient. The patient reports mood swings, sleep
disturbances, and difficulty concentrating. Which assessment tool is most appropriate
to systematically evaluate the patient's current mental status and guide differential
diagnosis?
A. Beck Depression Inventory
B. Mini-Mental State Examination
C. Mental Status Examination
D. Hamilton Rating Scale for Anxiety
Correct Answer:
C — Mental Status Examination
Rationale:
The Mental Status Examination provides a comprehensive, structured assessment of
appearance, behavior, mood, affect, thought process, thought content, cognition, insight,
and judgment, forming the foundation for differential diagnosis. The Beck Depression
Inventory and Hamilton Anxiety Scale screen specific conditions; the MMSE assesses
cognitive impairment.
,Question 2
A PMHNP is formulating a differential diagnosis for a patient presenting with auditory
hallucinations and disorganized speech. Which framework is most essential for
distinguishing between schizophrenia, bipolar disorder with psychotic features, and
substance-induced psychotic disorder?
A. The biopsychosocial model only
B. The DSM-5-TR diagnostic criteria and rule-out methodology
C. The Maslow hierarchy of needs
D. The nursing process assessment phase only
Correct Answer:
B — The DSM-5-TR diagnostic criteria and rule-out methodology
Rationale:
The DSM-5-TR provides specific criteria, duration requirements, and exclusion rules
(e.g., substance-induced, medical condition) that are essential for differential diagnosis
of psychotic disorders. The biopsychosocial model informs understanding but does not
provide diagnostic specificity; Maslow's hierarchy is unrelated to differential diagnosis.
Question 3
A 19-year-old college student presents with sudden onset of paranoia, visual
hallucinations, and agitation after using a synthetic cannabinoid. The symptoms resolve
within 72 hours. Which diagnosis is most appropriate?
A. Schizophrenia
B. Brief psychotic disorder
C. Substance-induced psychotic disorder
D. Schizoaffective disorder
Correct Answer:
C — Substance-induced psychotic disorder
,Rationale:
Substance-induced psychotic disorder is diagnosed when psychotic symptoms are
attributable to substance use and resolve within a reasonable timeframe after
cessation. Schizophrenia requires 6 months of symptoms; brief psychotic disorder
occurs without substance use; schizoaffective disorder requires a mood episode
concurrent with psychosis.
Question 4
A PMHNP is evaluating a patient who reports depressed mood, anhedonia, fatigue, and
difficulty concentrating. The patient denies suicidal ideation but has a family history of
bipolar disorder. Which screening strategy is most critical before initiating
antidepressant therapy?
A. Administer a comprehensive metabolic panel
B. Screen for history of manic or hypomanic episodes
C. Order an electroencephalogram
D. Perform a lumbar puncture
Correct Answer:
B — Screen for history of manic or hypomanic episodes
Rationale:
Antidepressant monotherapy in bipolar disorder can precipitate manic episodes;
screening for past mania/hypomania is essential before initiating antidepressants. A
metabolic panel assesses general health; EEG and lumbar puncture are not indicated for
mood disorder evaluation.
Question 5
A patient presents with symptoms of depression, but the PMHNP notes that the patient
has been taking prednisone 40 mg daily for 3 weeks for an autoimmune condition.
Which diagnostic consideration is most appropriate?
, A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Depressive disorder due to another medical condition (corticosteroid-induced)
D. Persistent depressive disorder (dysthymia)
Correct Answer:
C — Depressive disorder due to another medical condition (corticosteroid-induced)
Rationale:
Corticosteroids are known to cause mood disturbances including depression and
mania; when symptoms are attributable to a medication or medical condition, the
appropriate diagnosis is depressive disorder due to another medical condition. Major
depressive disorder requires exclusion of substance/medical causes.
──────────────────────────────
SECTION 2: MOOD DISORDERS AND DIFFERENTIAL DIAGNOSIS
──────────────────────────────
Question 6
A 28-year-old patient reports episodes of elevated mood, decreased need for sleep,
increased goal-directed activity, and impulsive spending lasting 4 days, interspersed
with periods of normal mood. Which diagnosis is most appropriate?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder with seasonal pattern
Correct Answer:
B — Bipolar II disorder
Rationale:
Bipolar II disorder is characterized by at least one hypomanic episode (4+ days, not
causing severe impairment) and at least one major depressive episode. Bipolar I
