NR 547 Midterm Exam Differential Diagnosis in Psychiatric-Mental Health
Practicum Chamberlain College of Nursing Question Bank (Latest 2026/2027
Edition) – 100% Correct Questions, Answers & Detailed Rationales
Total Questions: 50
Time Allowed: 90 Minutes
Passing Score: 80%
Instructions: Select the BEST answer for each question based on the 6-step differential
diagnosis process, DSM-5-TR criteria, laboratory interpretation, and clinical reasoning.
For SATA questions, select all that apply.
SECTION 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS & DSM-5-TR
Questions 1–10
Question 1
A 34-year-old man presents for psychiatric evaluation stating he hears voices telling him
to harm others. He recently filed a disability claim and is seeking a diagnosis of
schizophrenia to support his case. His reported symptoms shift dramatically between
visits, and he becomes defensive when asked detailed questions. Which step of the
6-step differential diagnosis process is the priority for the PMHNP to address first?
A. Step 3: Rule out disorder due to a medical condition
B. Step 4: Determine the specific primary disorder using DSM-5-TR criteria
C. Step 1: Rule out malingering or factitious disorder
D. Step 6: Establish boundary with no mental disorder
Correct Answer: C
Rationale: The 6-step differential diagnosis process requires the PMHNP to first rule out
malingering or factitious disorder before proceeding to other diagnostic considerations.
This patient's presentation includes key indicators of malingering: an external incentive
(disability claim), symptoms that conform to a lay perception of mental illness (hearing
,voices in schizophrenia), radical shifting of symptoms between encounters, and
defensive behavior when questioned. Malingering involves the intentional production of
false or exaggerated symptoms motivated by external incentives. The PMHNP must
first evaluate the authenticity of the presentation before applying DSM-5-TR criteria for a
primary psychiatric disorder.
Question 2
A 28-year-old woman has been admitted to the hospital three times in the past year with
severe abdominal pain, fever, and vomiting. Extensive medical workups have been
negative. She appears to enjoy the attention from medical staff and has a history of
secretly manipulating her IV lines. She has no pending legal or financial claims. Which
diagnosis best fits this presentation?
A. Malingering
B. Factitious disorder imposed on self
C. Somatic symptom disorder
D. Conversion disorder
Correct Answer: B
Rationale: Factitious disorder imposed on self involves the intentional falsification of
physical or psychological signs or symptoms in the absence of obvious external
rewards. This patient is deliberately inducing illness (manipulating IV lines) to assume
the sick role, with the primary gain being psychological (attention, care) rather than
external incentives. Malingering (A) is incorrect because there is no external incentive
(legal, financial, or drug-seeking). Somatic symptom disorder (C) involves genuine
distress about symptoms without intentional production. Conversion disorder (D)
involves neurological symptoms incompatible with recognized conditions, without
conscious intent.
Question 3
,A 45-year-old patient presents with depressive symptoms that began 2 weeks after
starting a new medication for hypertension. Which principle of the 6-step differential
diagnosis process best guides the PMHNP's next action?
A. If symptoms attributable to a substance begin after starting the substance, the
substance is likely the etiology
B. If symptoms persist beyond 1 month after stopping the substance, a primary
psychiatric disorder should be diagnosed
C. If the patient has a family history of depression, the symptoms are primary
regardless of medication timing
D. If the medication is prescribed by a physician, it cannot cause psychiatric symptoms
Correct Answer: A
Rationale: Step 2 of the 6-step differential diagnosis process requires ruling out
substance etiology. The temporal relationship between symptom onset and
substance/medication initiation is critical. If psychiatric symptoms begin after starting
a substance and resolve when the substance is discontinued, the substance is the likely
etiology. Many antihypertensives (e.g., beta-blockers, methyldopa) can cause
depressive symptoms. The PMHNP should evaluate the medication list, consider
discontinuation or substitution, and monitor symptom resolution. If symptoms persist
>1 month after stopping the substance, a primary psychiatric disorder is considered.
Question 4
A patient presents with manic symptoms. The PMHNP reviews the timeline and finds
that symptoms began 3 months after the onset of hyperthyroidism, worsen when
thyroid levels are elevated, and improve with antithyroid treatment. According to the
6-step differential diagnosis process, which conclusion is most appropriate?
A. Bipolar I disorder is the primary diagnosis because mania is present
B. The symptoms are due to a medical condition (hyperthyroidism) and do not warrant a
separate psychiatric diagnosis
C. Adjustment disorder with mixed anxiety and depressed mood should be diagnosed
D. The patient has no mental disorder and requires no treatment
, Correct Answer: B
Rationale: Step 3 of the 6-step differential diagnosis process requires ruling out
disorders due to a medical condition. When psychiatric symptoms begin after the onset
of a medical condition, vary in severity with the medical condition, and disappear when
the medical condition resolves, the medical condition is the etiology. Hyperthyroidism is
a well-established cause of manic-like symptoms (thyrotoxicosis). The PMHNP should
treat or refer for the underlying medical condition rather than diagnosing a primary
psychiatric disorder. A separate psychiatric diagnosis is only warranted if symptoms
persist after the medical condition is resolved.
Question 5
Which components are essential for establishing an accurate differential diagnosis
using the DSM-5-TR? Select all that apply.
A. Evaluating the presence of diagnostic criteria for the suspected disorder
B. Applying appropriate specifiers (e.g., severity, course, descriptive features)
C. Ruling out substance-induced and medical condition etiologies before assigning a
primary diagnosis
D. Documenting the patient's social security number for insurance verification
E. Determining the level of psychosocial stressors to differentiate adjustment disorders
from other specified disorders
Correct Answers: A, B, C, E
Rationale: The DSM-5-TR diagnostic process requires evaluating all diagnostic criteria
for the suspected disorder (A), applying specifiers to enhance diagnostic precision (B),
and ruling out substance and medical etiologies before assigning a primary psychiatric
diagnosis (C)—this aligns with Steps 2, 3, and 4 of the 6-step process. Step 5 requires
differentiating adjustment disorders (symptoms in response to identifiable stressors)
from other specified/unspecified disorders. Option D is incorrect; social security
numbers and insurance information are administrative, not clinical diagnostic
components.
Practicum Chamberlain College of Nursing Question Bank (Latest 2026/2027
Edition) – 100% Correct Questions, Answers & Detailed Rationales
Total Questions: 50
Time Allowed: 90 Minutes
Passing Score: 80%
Instructions: Select the BEST answer for each question based on the 6-step differential
diagnosis process, DSM-5-TR criteria, laboratory interpretation, and clinical reasoning.
For SATA questions, select all that apply.
SECTION 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS & DSM-5-TR
Questions 1–10
Question 1
A 34-year-old man presents for psychiatric evaluation stating he hears voices telling him
to harm others. He recently filed a disability claim and is seeking a diagnosis of
schizophrenia to support his case. His reported symptoms shift dramatically between
visits, and he becomes defensive when asked detailed questions. Which step of the
6-step differential diagnosis process is the priority for the PMHNP to address first?
A. Step 3: Rule out disorder due to a medical condition
B. Step 4: Determine the specific primary disorder using DSM-5-TR criteria
C. Step 1: Rule out malingering or factitious disorder
D. Step 6: Establish boundary with no mental disorder
Correct Answer: C
Rationale: The 6-step differential diagnosis process requires the PMHNP to first rule out
malingering or factitious disorder before proceeding to other diagnostic considerations.
This patient's presentation includes key indicators of malingering: an external incentive
(disability claim), symptoms that conform to a lay perception of mental illness (hearing
,voices in schizophrenia), radical shifting of symptoms between encounters, and
defensive behavior when questioned. Malingering involves the intentional production of
false or exaggerated symptoms motivated by external incentives. The PMHNP must
first evaluate the authenticity of the presentation before applying DSM-5-TR criteria for a
primary psychiatric disorder.
Question 2
A 28-year-old woman has been admitted to the hospital three times in the past year with
severe abdominal pain, fever, and vomiting. Extensive medical workups have been
negative. She appears to enjoy the attention from medical staff and has a history of
secretly manipulating her IV lines. She has no pending legal or financial claims. Which
diagnosis best fits this presentation?
A. Malingering
B. Factitious disorder imposed on self
C. Somatic symptom disorder
D. Conversion disorder
Correct Answer: B
Rationale: Factitious disorder imposed on self involves the intentional falsification of
physical or psychological signs or symptoms in the absence of obvious external
rewards. This patient is deliberately inducing illness (manipulating IV lines) to assume
the sick role, with the primary gain being psychological (attention, care) rather than
external incentives. Malingering (A) is incorrect because there is no external incentive
(legal, financial, or drug-seeking). Somatic symptom disorder (C) involves genuine
distress about symptoms without intentional production. Conversion disorder (D)
involves neurological symptoms incompatible with recognized conditions, without
conscious intent.
Question 3
,A 45-year-old patient presents with depressive symptoms that began 2 weeks after
starting a new medication for hypertension. Which principle of the 6-step differential
diagnosis process best guides the PMHNP's next action?
A. If symptoms attributable to a substance begin after starting the substance, the
substance is likely the etiology
B. If symptoms persist beyond 1 month after stopping the substance, a primary
psychiatric disorder should be diagnosed
C. If the patient has a family history of depression, the symptoms are primary
regardless of medication timing
D. If the medication is prescribed by a physician, it cannot cause psychiatric symptoms
Correct Answer: A
Rationale: Step 2 of the 6-step differential diagnosis process requires ruling out
substance etiology. The temporal relationship between symptom onset and
substance/medication initiation is critical. If psychiatric symptoms begin after starting
a substance and resolve when the substance is discontinued, the substance is the likely
etiology. Many antihypertensives (e.g., beta-blockers, methyldopa) can cause
depressive symptoms. The PMHNP should evaluate the medication list, consider
discontinuation or substitution, and monitor symptom resolution. If symptoms persist
>1 month after stopping the substance, a primary psychiatric disorder is considered.
Question 4
A patient presents with manic symptoms. The PMHNP reviews the timeline and finds
that symptoms began 3 months after the onset of hyperthyroidism, worsen when
thyroid levels are elevated, and improve with antithyroid treatment. According to the
6-step differential diagnosis process, which conclusion is most appropriate?
A. Bipolar I disorder is the primary diagnosis because mania is present
B. The symptoms are due to a medical condition (hyperthyroidism) and do not warrant a
separate psychiatric diagnosis
C. Adjustment disorder with mixed anxiety and depressed mood should be diagnosed
D. The patient has no mental disorder and requires no treatment
, Correct Answer: B
Rationale: Step 3 of the 6-step differential diagnosis process requires ruling out
disorders due to a medical condition. When psychiatric symptoms begin after the onset
of a medical condition, vary in severity with the medical condition, and disappear when
the medical condition resolves, the medical condition is the etiology. Hyperthyroidism is
a well-established cause of manic-like symptoms (thyrotoxicosis). The PMHNP should
treat or refer for the underlying medical condition rather than diagnosing a primary
psychiatric disorder. A separate psychiatric diagnosis is only warranted if symptoms
persist after the medical condition is resolved.
Question 5
Which components are essential for establishing an accurate differential diagnosis
using the DSM-5-TR? Select all that apply.
A. Evaluating the presence of diagnostic criteria for the suspected disorder
B. Applying appropriate specifiers (e.g., severity, course, descriptive features)
C. Ruling out substance-induced and medical condition etiologies before assigning a
primary diagnosis
D. Documenting the patient's social security number for insurance verification
E. Determining the level of psychosocial stressors to differentiate adjustment disorders
from other specified disorders
Correct Answers: A, B, C, E
Rationale: The DSM-5-TR diagnostic process requires evaluating all diagnostic criteria
for the suspected disorder (A), applying specifiers to enhance diagnostic precision (B),
and ruling out substance and medical etiologies before assigning a primary psychiatric
diagnosis (C)—this aligns with Steps 2, 3, and 4 of the 6-step process. Step 5 requires
differentiating adjustment disorders (symptoms in response to identifiable stressors)
from other specified/unspecified disorders. Option D is incorrect; social security
numbers and insurance information are administrative, not clinical diagnostic
components.
