==============================
EXAM TITLE: NR547 Final Exam Differential Diagnosis Psychiatric-Mental
Health Questions | 100% Correct Answers with Detailed Rationales
(2026/2027 Edition)
==============================
SECTION 1: Neurodevelopmental Disorders – Differential Diagnosis and Comorbidities
Question 1
A 7-year-old boy is referred for evaluation due to persistent difficulties in school. His teacher reports
that he cannot remain seated, blurts out answers before questions are completed, and frequently
loses materials necessary for tasks. At home, his parents note he is easily distracted by extraneous
stimuli and avoids activities requiring sustained mental effort. Symptoms have been present since
age 5 and occur in multiple settings. A comprehensive medical workup, including hearing and vision
screening, is unremarkable. Which diagnosis is most consistent with this presentation?
A. Autism Spectrum Disorder
B. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
C. Oppositional Defiant Disorder
D. Specific Learning Disorder with Impairment in Reading
Correct Answer: B
Rationale: The presentation is classic for Attention-Deficit/Hyperactivity Disorder (ADHD), Combined
Presentation, per DSM-5-TR criteria. The child demonstrates sufficient symptoms of both inattention
(easily distracted, loses materials, avoids sustained mental effort) and hyperactivity-impulsivity
(cannot remain seated, blurts out answers) that have been present before age 12, occur in two or
more settings, and cause functional impairment. Autism Spectrum Disorder would require persistent
deficits in social communication and restricted, repetitive patterns of behavior, which are not
described. Oppositional Defiant Disorder is characterized by angry/irritable mood,
argumentative/defiant behavior, or vindictiveness, not primarily inattention and hyperactivity. Specific
Learning Disorder would present with specific academic skill deficits despite adequate instruction,
not the global attention and behavioral dysregulation seen here.
------------------------------
Question 2
A 4-year-old girl is brought for evaluation because she has not yet developed spoken language, does
not respond to her name, and engages in repetitive hand-flapping. She lines up toys in precise rows
,and becomes extremely distressed when her routine is altered. She makes limited eye contact and
does not engage in pretend play. Her developmental pediatrician has ruled out hearing impairment
and intellectual disability. Which diagnosis best explains this presentation?
A. Social Communication Disorder
B. Autism Spectrum Disorder, Level 2 Requiring Substantial Support
C. Childhood-Onset Fluency Disorder (Stuttering)
D. Reactive Attachment Disorder
Correct Answer: B
Rationale: This presentation is consistent with Autism Spectrum Disorder (ASD), Level 2 Requiring
Substantial Support, per DSM-5-TR criteria. The child demonstrates persistent deficits in social
communication (no spoken language, limited eye contact, does not respond to name, no pretend
play) and restricted, repetitive patterns of behavior (hand-flapping, lining up toys, distress with
routine changes). The severity level is determined by the substantial support required for social
communication and restricted behaviors. Social Communication Disorder includes pragmatic
communication deficits without restricted/repetitive behaviors. Childhood-Onset Fluency Disorder
involves speech dysfluency, not the broad social and behavioral deficits seen here. Reactive
Attachment Disorder requires a history of social neglect or deprivation and presents with
emotionally withdrawn behavior, not the specific repetitive behaviors and social communication
deficits characteristic of ASD.
------------------------------
Question 3
A 16-year-old adolescent is referred for psychiatric evaluation due to declining academic
performance. He reports that he has always had difficulty sustaining attention in class and
frequently daydreams. He is not hyperactive or impulsive. His parents describe him as a "spacey"
child who often forgets chores and loses belongings. He has no history of mood episodes,
substance use, or trauma. Which diagnosis is most appropriate?
A. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation
B. Major Depressive Disorder, Single Episode
C. Generalized Anxiety Disorder
D. Disruptive Mood Dysregulation Disorder
Correct Answer: A
Rationale: This adolescent presents with Attention-Deficit/Hyperactivity Disorder, Predominantly
Inattentive Presentation. The key features include difficulty sustaining attention, frequent
daydreaming, forgetfulness, and losing belongings, without significant hyperactivity or impulsivity.
Symptoms have been present since childhood ("always had difficulty") and cause functional
,impairment (declining academic performance). In adolescents, the inattentive presentation is often
missed because hyperactivity is absent. Major Depressive Disorder would require depressed mood
or anhedonia plus associated symptoms (sleep disturbance, appetite changes, psychomotor
changes, guilt, suicidal ideation) for at least 2 weeks. Generalized Anxiety Disorder requires
excessive worry and associated symptoms (restlessness, fatigue, concentration difficulty, irritability,
muscle tension, sleep disturbance) that are not better explained by another condition. Disruptive
Mood Dysregulation Disorder requires severe, recurrent temper outbursts inconsistent with
developmental level, which are absent here.
------------------------------
Question 4
A 9-year-old boy with a known diagnosis of ADHD, Combined Presentation, is re-evaluated because
his symptoms have not improved with stimulant medication. His parents report that he also has
significant anxiety about separating from his mother, refuses to sleep alone, and has recurrent
stomachaches before school. He worries excessively about harm befalling his parents. Which
comorbid condition should the psychiatric-mental health nurse practitioner consider?
A. Conduct Disorder
B. Separation Anxiety Disorder
C. Intermittent Explosive Disorder
D. Tourette's Disorder
Correct Answer: B
Rationale: Separation Anxiety Disorder is a common comorbidity in children with ADHD. The
presentation of excessive distress when separated from attachment figures, refusal to sleep alone,
recurrent physical complaints (somatic symptoms of anxiety), and excessive worry about harm to
parents meets DSM-5-TR criteria for Separation Anxiety Disorder. The presence of this comorbid
anxiety may also explain the partial response to stimulant medication, as stimulants can sometimes
worsen anxiety symptoms. Conduct Disorder would require a repetitive pattern of violating the rights
of others or societal norms (aggression, destruction of property, deceitfulness, theft). Intermittent
Explosive Disorder involves recurrent behavioral outbursts representing failure to control aggressive
impulses. Tourette's Disorder requires multiple motor tics and at least one vocal tic present for at
least one year.
------------------------------
Question 5
A 10-year-old girl is evaluated for academic difficulties. Psychological testing reveals a full-scale IQ
of 68 with significant deficits in adaptive functioning across conceptual, social, and practical
domains. She requires substantial support to complete daily living activities and cannot read beyond
, a first-grade level despite intensive intervention. Her parents ask whether her difficulties are due to a
specific learning disability. Which response is most accurate?
A. The presentation is consistent with Specific Learning Disorder because academic skills are below
expected levels
B. The presentation is consistent with Intellectual Disability because of the combination of low IQ
and adaptive functioning deficits
C. The presentation is consistent with Autism Spectrum Disorder because of the need for
substantial support
D. The presentation is consistent with Language Disorder because reading is the primary deficit
Correct Answer: B
Rationale: Intellectual Disability (Intellectual Developmental Disorder) is diagnosed when there are
deficits in intellectual functioning (IQ approximately 70 or below, with consideration of measurement
error) and deficits in adaptive functioning that result in failure to meet developmental and
sociocultural standards for personal independence and social responsibility. The diagnosis requires
onset during the developmental period. This child's full-scale IQ of 68, combined with significant
adaptive functioning deficits across all three domains (conceptual, social, practical) and the need for
substantial support, meets criteria for Intellectual Disability. Specific Learning Disorder requires
average intellectual ability with specific academic skill deficits; an IQ of 68 is below the range
typically associated with specific learning disorder. ASD requires deficits in social communication
and restricted/repetitive behaviors, not described here. Language Disorder involves persistent
difficulties in language acquisition and use but does not encompass the global intellectual and
adaptive deficits seen in this case.
------------------------------
Question 6
A 14-year-old adolescent with ADHD is prescribed methylphenidate. After 3 months, his parents
report improved focus but note he now has frequent facial grimacing, throat clearing, and shoulder
shrugging that were not present before medication initiation. Which diagnosis should the
psychiatric-mental health nurse practitioner consider?
A. Tardive Dyskinesia
B. Tourette's Disorder
C. Medication-Induced Acute Dystonia
D. Stereotypic Movement Disorder
Correct Answer: B
Rationale: The emergence of multiple motor tics (facial grimacing, shoulder shrugging) and at least
one vocal tic (throat clearing) in an adolescent with ADHD is most consistent with Tourette's
EXAM TITLE: NR547 Final Exam Differential Diagnosis Psychiatric-Mental
Health Questions | 100% Correct Answers with Detailed Rationales
(2026/2027 Edition)
==============================
SECTION 1: Neurodevelopmental Disorders – Differential Diagnosis and Comorbidities
Question 1
A 7-year-old boy is referred for evaluation due to persistent difficulties in school. His teacher reports
that he cannot remain seated, blurts out answers before questions are completed, and frequently
loses materials necessary for tasks. At home, his parents note he is easily distracted by extraneous
stimuli and avoids activities requiring sustained mental effort. Symptoms have been present since
age 5 and occur in multiple settings. A comprehensive medical workup, including hearing and vision
screening, is unremarkable. Which diagnosis is most consistent with this presentation?
A. Autism Spectrum Disorder
B. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
C. Oppositional Defiant Disorder
D. Specific Learning Disorder with Impairment in Reading
Correct Answer: B
Rationale: The presentation is classic for Attention-Deficit/Hyperactivity Disorder (ADHD), Combined
Presentation, per DSM-5-TR criteria. The child demonstrates sufficient symptoms of both inattention
(easily distracted, loses materials, avoids sustained mental effort) and hyperactivity-impulsivity
(cannot remain seated, blurts out answers) that have been present before age 12, occur in two or
more settings, and cause functional impairment. Autism Spectrum Disorder would require persistent
deficits in social communication and restricted, repetitive patterns of behavior, which are not
described. Oppositional Defiant Disorder is characterized by angry/irritable mood,
argumentative/defiant behavior, or vindictiveness, not primarily inattention and hyperactivity. Specific
Learning Disorder would present with specific academic skill deficits despite adequate instruction,
not the global attention and behavioral dysregulation seen here.
------------------------------
Question 2
A 4-year-old girl is brought for evaluation because she has not yet developed spoken language, does
not respond to her name, and engages in repetitive hand-flapping. She lines up toys in precise rows
,and becomes extremely distressed when her routine is altered. She makes limited eye contact and
does not engage in pretend play. Her developmental pediatrician has ruled out hearing impairment
and intellectual disability. Which diagnosis best explains this presentation?
A. Social Communication Disorder
B. Autism Spectrum Disorder, Level 2 Requiring Substantial Support
C. Childhood-Onset Fluency Disorder (Stuttering)
D. Reactive Attachment Disorder
Correct Answer: B
Rationale: This presentation is consistent with Autism Spectrum Disorder (ASD), Level 2 Requiring
Substantial Support, per DSM-5-TR criteria. The child demonstrates persistent deficits in social
communication (no spoken language, limited eye contact, does not respond to name, no pretend
play) and restricted, repetitive patterns of behavior (hand-flapping, lining up toys, distress with
routine changes). The severity level is determined by the substantial support required for social
communication and restricted behaviors. Social Communication Disorder includes pragmatic
communication deficits without restricted/repetitive behaviors. Childhood-Onset Fluency Disorder
involves speech dysfluency, not the broad social and behavioral deficits seen here. Reactive
Attachment Disorder requires a history of social neglect or deprivation and presents with
emotionally withdrawn behavior, not the specific repetitive behaviors and social communication
deficits characteristic of ASD.
------------------------------
Question 3
A 16-year-old adolescent is referred for psychiatric evaluation due to declining academic
performance. He reports that he has always had difficulty sustaining attention in class and
frequently daydreams. He is not hyperactive or impulsive. His parents describe him as a "spacey"
child who often forgets chores and loses belongings. He has no history of mood episodes,
substance use, or trauma. Which diagnosis is most appropriate?
A. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation
B. Major Depressive Disorder, Single Episode
C. Generalized Anxiety Disorder
D. Disruptive Mood Dysregulation Disorder
Correct Answer: A
Rationale: This adolescent presents with Attention-Deficit/Hyperactivity Disorder, Predominantly
Inattentive Presentation. The key features include difficulty sustaining attention, frequent
daydreaming, forgetfulness, and losing belongings, without significant hyperactivity or impulsivity.
Symptoms have been present since childhood ("always had difficulty") and cause functional
,impairment (declining academic performance). In adolescents, the inattentive presentation is often
missed because hyperactivity is absent. Major Depressive Disorder would require depressed mood
or anhedonia plus associated symptoms (sleep disturbance, appetite changes, psychomotor
changes, guilt, suicidal ideation) for at least 2 weeks. Generalized Anxiety Disorder requires
excessive worry and associated symptoms (restlessness, fatigue, concentration difficulty, irritability,
muscle tension, sleep disturbance) that are not better explained by another condition. Disruptive
Mood Dysregulation Disorder requires severe, recurrent temper outbursts inconsistent with
developmental level, which are absent here.
------------------------------
Question 4
A 9-year-old boy with a known diagnosis of ADHD, Combined Presentation, is re-evaluated because
his symptoms have not improved with stimulant medication. His parents report that he also has
significant anxiety about separating from his mother, refuses to sleep alone, and has recurrent
stomachaches before school. He worries excessively about harm befalling his parents. Which
comorbid condition should the psychiatric-mental health nurse practitioner consider?
A. Conduct Disorder
B. Separation Anxiety Disorder
C. Intermittent Explosive Disorder
D. Tourette's Disorder
Correct Answer: B
Rationale: Separation Anxiety Disorder is a common comorbidity in children with ADHD. The
presentation of excessive distress when separated from attachment figures, refusal to sleep alone,
recurrent physical complaints (somatic symptoms of anxiety), and excessive worry about harm to
parents meets DSM-5-TR criteria for Separation Anxiety Disorder. The presence of this comorbid
anxiety may also explain the partial response to stimulant medication, as stimulants can sometimes
worsen anxiety symptoms. Conduct Disorder would require a repetitive pattern of violating the rights
of others or societal norms (aggression, destruction of property, deceitfulness, theft). Intermittent
Explosive Disorder involves recurrent behavioral outbursts representing failure to control aggressive
impulses. Tourette's Disorder requires multiple motor tics and at least one vocal tic present for at
least one year.
------------------------------
Question 5
A 10-year-old girl is evaluated for academic difficulties. Psychological testing reveals a full-scale IQ
of 68 with significant deficits in adaptive functioning across conceptual, social, and practical
domains. She requires substantial support to complete daily living activities and cannot read beyond
, a first-grade level despite intensive intervention. Her parents ask whether her difficulties are due to a
specific learning disability. Which response is most accurate?
A. The presentation is consistent with Specific Learning Disorder because academic skills are below
expected levels
B. The presentation is consistent with Intellectual Disability because of the combination of low IQ
and adaptive functioning deficits
C. The presentation is consistent with Autism Spectrum Disorder because of the need for
substantial support
D. The presentation is consistent with Language Disorder because reading is the primary deficit
Correct Answer: B
Rationale: Intellectual Disability (Intellectual Developmental Disorder) is diagnosed when there are
deficits in intellectual functioning (IQ approximately 70 or below, with consideration of measurement
error) and deficits in adaptive functioning that result in failure to meet developmental and
sociocultural standards for personal independence and social responsibility. The diagnosis requires
onset during the developmental period. This child's full-scale IQ of 68, combined with significant
adaptive functioning deficits across all three domains (conceptual, social, practical) and the need for
substantial support, meets criteria for Intellectual Disability. Specific Learning Disorder requires
average intellectual ability with specific academic skill deficits; an IQ of 68 is below the range
typically associated with specific learning disorder. ASD requires deficits in social communication
and restricted/repetitive behaviors, not described here. Language Disorder involves persistent
difficulties in language acquisition and use but does not encompass the global intellectual and
adaptive deficits seen in this case.
------------------------------
Question 6
A 14-year-old adolescent with ADHD is prescribed methylphenidate. After 3 months, his parents
report improved focus but note he now has frequent facial grimacing, throat clearing, and shoulder
shrugging that were not present before medication initiation. Which diagnosis should the
psychiatric-mental health nurse practitioner consider?
A. Tardive Dyskinesia
B. Tourette's Disorder
C. Medication-Induced Acute Dystonia
D. Stereotypic Movement Disorder
Correct Answer: B
Rationale: The emergence of multiple motor tics (facial grimacing, shoulder shrugging) and at least
one vocal tic (throat clearing) in an adolescent with ADHD is most consistent with Tourette's
