NR547 FINAL EXAM 2026/2027
Differential Diagnosis Psychiatric-Mental Health Across
Lifespan
Weeks 5-8 Practicum Exam Review
Complete Guide Chamberlain University actual!!!!
Real!!
SECTION 1: WEEKS 5-8 OVERVIEW & DIFFERENTIAL DIAGNOSIS PROCESS REVIEW
Question 1
According to the DSM-5-TR differential diagnosis hierarchy, which step should be completed FIRST
before determining a primary mental disorder?
A. Determine the specific primary mental disorder based on symptom clusters
B. Rule out malingering and factitious disorder
C. Rule out substance/medication-induced conditions
D. Rule out medical conditions that may explain symptoms
ANSWER: B. Rule out malingering and factitious disorder
Rationale: The DSM-5-TR differential diagnosis hierarchy prioritizes ruling out malingering and factitious
disorder first, as these involve intentional deception that must be distinguished from genuine
psychopathology. Step 2 rules out substance/medication-induced conditions (Option C), and Step 3 rules
out medical conditions (Option D). Step 4 determines the specific primary mental disorder (Option A).
This hierarchy ensures that organic, intentional, and iatrogenic causes are excluded before assigning a
primary psychiatric diagnosis.
,Question 2
A 45-year-old patient presents with hallucinations, delusions, and disorganized speech. The PMHNP
should first:
A. Diagnose schizophrenia based on symptom presentation
B. Order a comprehensive metabolic panel and toxicology screen
C. Assess for malingering and factitious disorder
D. Begin antipsychotic medication immediately
ANSWER: C. Assess for malingering and factitious disorder
Rationale: According to the DSM-5-TR hierarchy, ruling out malingering and factitious disorder is the first
step before considering other etiologies. Option A is premature without ruling out other causes. Option
B would be appropriate as Step 2 after ruling out intentional deception. Option D would be clinically
inappropriate without a confirmed diagnosis and proper assessment.
Question 3
Which of the following represents the correct sequential order of the DSM-5-TR differential diagnosis
hierarchy?
A. Substance-induced conditions → Medical conditions → Malingering → Primary disorder
B. Medical conditions → Substance-induced → Malingering → Primary disorder
C. Malingering/Factitious → Substance/medication-induced → Medical conditions → Primary disorder
D. Primary disorder → Malingering → Substance-induced → Medical conditions
ANSWER: C. Malingering/Factitious → Substance/medication-induced → Medical conditions → Primary
disorder
Rationale: The correct hierarchy is: Step 1 - Rule out malingering and factitious disorder; Step 2 - Rule
out substance/medication-induced conditions; Step 3 - Rule out medical conditions; Step 4 - Determine
,the specific primary mental disorder. Option A reverses the order. Option B places medical conditions
before substance-induced, which is incorrect. Option D completely reverses the hierarchy.
Question 4
A 28-year-old female presents with symptoms of depression. She reports significant life stressors and
has a history of thyroid disease. What is the PMHNP's priority action?
A. Prescribe an SSRI for major depressive disorder
B. Order thyroid function tests
C. Assess for factitious disorder
D. Refer for cognitive behavioral therapy
ANSWER: C. Assess for factitious disorder
Rationale: While thyroid function tests (Option B) are important, the DSM-5-TR hierarchy requires ruling
out malingering and factitious disorder first. Option A is premature without completing the differential
diagnosis process. Option D may be appropriate later but is not the priority action.
Question 5
A 16-year-old adolescent is brought to the clinic by parents who report the teen has been "acting
strangely" and "making up stories" about being followed. The PMHNP should:
A. Diagnose early-onset schizophrenia
B. Assess for malingering and factitious disorder
C. Order a head CT immediately
D. Hospitalize for psychotic symptoms
ANSWER: B. Assess for malingering and factitious disorder
Rationale: The presence of unusual stories and parental concern about fabrication warrants assessment
for malingering or factitious disorder as the first step in the differential diagnosis hierarchy. Option A is
, premature without ruling out other causes. Option C may be indicated later but is not the first step.
Option D is not indicated without proper assessment.
Question 6
The PMHNP is evaluating a patient who reports auditory hallucinations. Which question best helps rule
out malingering?
A. "Are the voices telling you to harm yourself?"
B. "Have you ever been diagnosed with a mental illness?"
C. "What do you hope to gain from this evaluation?"
D. "When did the voices first start?"
ANSWER: C. "What do you hope to gain from this evaluation?"
Rationale: Directly asking about secondary gain, motivations, or expectations from the evaluation can
help identify potential malingering. Options A, B, and D are clinically appropriate questions but do not
specifically address the possibility of malingering or intentional deception.
Question 7
A 55-year-old patient with no psychiatric history presents with new-onset confusion, hallucinations, and
memory problems. The PMHNP should first:
A. Diagnose Alzheimer's disease
B. Assess for factitious disorder
C. Order a complete blood count and metabolic panel
D. Prescribe an antipsychotic for symptom management
ANSWER: B. Assess for factitious disorder
Rationale: Despite the patient's age and symptom presentation, the DSM-5-TR hierarchy requires ruling
out malingering and factitious disorder first. Option C is appropriate as Step 3 after ruling out intentional
Differential Diagnosis Psychiatric-Mental Health Across
Lifespan
Weeks 5-8 Practicum Exam Review
Complete Guide Chamberlain University actual!!!!
Real!!
SECTION 1: WEEKS 5-8 OVERVIEW & DIFFERENTIAL DIAGNOSIS PROCESS REVIEW
Question 1
According to the DSM-5-TR differential diagnosis hierarchy, which step should be completed FIRST
before determining a primary mental disorder?
A. Determine the specific primary mental disorder based on symptom clusters
B. Rule out malingering and factitious disorder
C. Rule out substance/medication-induced conditions
D. Rule out medical conditions that may explain symptoms
ANSWER: B. Rule out malingering and factitious disorder
Rationale: The DSM-5-TR differential diagnosis hierarchy prioritizes ruling out malingering and factitious
disorder first, as these involve intentional deception that must be distinguished from genuine
psychopathology. Step 2 rules out substance/medication-induced conditions (Option C), and Step 3 rules
out medical conditions (Option D). Step 4 determines the specific primary mental disorder (Option A).
This hierarchy ensures that organic, intentional, and iatrogenic causes are excluded before assigning a
primary psychiatric diagnosis.
,Question 2
A 45-year-old patient presents with hallucinations, delusions, and disorganized speech. The PMHNP
should first:
A. Diagnose schizophrenia based on symptom presentation
B. Order a comprehensive metabolic panel and toxicology screen
C. Assess for malingering and factitious disorder
D. Begin antipsychotic medication immediately
ANSWER: C. Assess for malingering and factitious disorder
Rationale: According to the DSM-5-TR hierarchy, ruling out malingering and factitious disorder is the first
step before considering other etiologies. Option A is premature without ruling out other causes. Option
B would be appropriate as Step 2 after ruling out intentional deception. Option D would be clinically
inappropriate without a confirmed diagnosis and proper assessment.
Question 3
Which of the following represents the correct sequential order of the DSM-5-TR differential diagnosis
hierarchy?
A. Substance-induced conditions → Medical conditions → Malingering → Primary disorder
B. Medical conditions → Substance-induced → Malingering → Primary disorder
C. Malingering/Factitious → Substance/medication-induced → Medical conditions → Primary disorder
D. Primary disorder → Malingering → Substance-induced → Medical conditions
ANSWER: C. Malingering/Factitious → Substance/medication-induced → Medical conditions → Primary
disorder
Rationale: The correct hierarchy is: Step 1 - Rule out malingering and factitious disorder; Step 2 - Rule
out substance/medication-induced conditions; Step 3 - Rule out medical conditions; Step 4 - Determine
,the specific primary mental disorder. Option A reverses the order. Option B places medical conditions
before substance-induced, which is incorrect. Option D completely reverses the hierarchy.
Question 4
A 28-year-old female presents with symptoms of depression. She reports significant life stressors and
has a history of thyroid disease. What is the PMHNP's priority action?
A. Prescribe an SSRI for major depressive disorder
B. Order thyroid function tests
C. Assess for factitious disorder
D. Refer for cognitive behavioral therapy
ANSWER: C. Assess for factitious disorder
Rationale: While thyroid function tests (Option B) are important, the DSM-5-TR hierarchy requires ruling
out malingering and factitious disorder first. Option A is premature without completing the differential
diagnosis process. Option D may be appropriate later but is not the priority action.
Question 5
A 16-year-old adolescent is brought to the clinic by parents who report the teen has been "acting
strangely" and "making up stories" about being followed. The PMHNP should:
A. Diagnose early-onset schizophrenia
B. Assess for malingering and factitious disorder
C. Order a head CT immediately
D. Hospitalize for psychotic symptoms
ANSWER: B. Assess for malingering and factitious disorder
Rationale: The presence of unusual stories and parental concern about fabrication warrants assessment
for malingering or factitious disorder as the first step in the differential diagnosis hierarchy. Option A is
, premature without ruling out other causes. Option C may be indicated later but is not the first step.
Option D is not indicated without proper assessment.
Question 6
The PMHNP is evaluating a patient who reports auditory hallucinations. Which question best helps rule
out malingering?
A. "Are the voices telling you to harm yourself?"
B. "Have you ever been diagnosed with a mental illness?"
C. "What do you hope to gain from this evaluation?"
D. "When did the voices first start?"
ANSWER: C. "What do you hope to gain from this evaluation?"
Rationale: Directly asking about secondary gain, motivations, or expectations from the evaluation can
help identify potential malingering. Options A, B, and D are clinically appropriate questions but do not
specifically address the possibility of malingering or intentional deception.
Question 7
A 55-year-old patient with no psychiatric history presents with new-onset confusion, hallucinations, and
memory problems. The PMHNP should first:
A. Diagnose Alzheimer's disease
B. Assess for factitious disorder
C. Order a complete blood count and metabolic panel
D. Prescribe an antipsychotic for symptom management
ANSWER: B. Assess for factitious disorder
Rationale: Despite the patient's age and symptom presentation, the DSM-5-TR hierarchy requires ruling
out malingering and factitious disorder first. Option C is appropriate as Step 3 after ruling out intentional
