NR 547 DIFFERENTIAL DX MIDTERM
EXAM QUESTIONS & DETAILED
CORRECT ANSWERS PASSED
Differential Dx - CORRECT ANSWER Diagnostic reasoning is the process of
questioning one's thinking to determine if all possible avenues have been explored and
if the conclusions that are drawn are based on evidence. This is a critical step for
providers who are trying to uncover a cause, or diagnosis, for their clients' signs and
symptoms. The provider's initial hypothesis is known as the differential diagnosis. The
differential diagnosis, or differential, is a working list of potential problems that can be
associated with the initial or chief complaint. Establishing a differential diagnosis is a
critical step in providing safe, quality care. This evolving process of clinical reasoning
and decision making involves examining the client's presentation, clinical data, and
when appropriate, screening and diagnostic test results to distinguish one disease from
another and arrive at the correct diagnosis. The Diagnostic and Statistical Manual of
Mental Disorders (DSM-5-TR)provides guidance for identifying psychiatric diagnosest
History of Present Illness - CORRECT ANSWER How long have you been feeling this
way?
Did something happen in your life that may have triggered these emotions?
How is this current situation impacting your life?
The Psychiatric History - CORRECT ANSWER Have you ever been hospitalized for
any mental health issues?
Have you ever had counseling or psychotherapy?
Have you ever taken medications for your mental health in the past?
Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions - CORRECT ANSWER Do
you have a primary care provider?
Do you have any medical illnesses?
Are you currently taking any medications or herbal supplements?
Do you have any allergies to medications?
Have you ever been hospitalized for any reason?
Have you ever had surgery?
Family Psychiatric History - CORRECT ANSWER Has any relative of yours ever been
hospitalized for a mental health issue?
Has any blood relative of yours ever been diagnosed with a mental health issue?
Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
,Social and Developmental History - CORRECT ANSWER Tell me a little bit about your
childhood and how you grew up.
How was your experience in school when you were younger? Did you enjoy school?
How do you support yourself with your finances?
Do you have a good support system? Are you currently in a relationship? Where do you
live? Who do you live with?
What do you do in your free time? What activities do you enjoy?
Which of the following should be included when providing client education about
medication regimens? Select all that apply. - CORRECT ANSWER A)Explain how the
medication targets the symptoms, specific benefits, and expected time course. (Correct
answer)
B)Identify potential side effects, duration of side effects, and adverse effects. (Correct
answer)
C)Explain the instructions, dosing, and special requirements. (Correct answer)
D)Use teach-back methods to ensure client understanding. (Correct answer)
Apply the Ask Suicide-Screening Questions (ASQ) Suicide Risk Screening Tool (Links
to an external site.) to the scenario below.
A 52-year-old client presents to the emergency department following a car accident.
The emergency department (ED) physician is concerned that the client may have
intentionally crashed her car and requests a stat PMHNP consult. In speaking with the
PMHNP, the client describes persistent feelings of sadness and hopelessness. She
states that she often wonders if her husband would be happier if she wasn't around
anymore since she's never happy and sometimes thinks about what it would be like to
just take a handful of sleeping pills and go to sleep forever. The client reports a previous
suicide attempt when she was 16 but denies that she is considering killing herself right
now.
Based on the client's ASQ score, what is the most appropriate response?
A) No action is necessary as the client is not - CORRECT ANSWER B)Provide a brief
suicide safety assessment.
Rationale: While the client's responses do not indicate a need for a stat full safety and
mental health evaluation, the client requires a brief suicide safety assessment to
determine whether a full mental health evaluation in necessary. It is also important to
notify the client's physician or the clinician responsible for the client's care.
Complete Blood Count - CORRECT ANSWER The CBC is a serum diagnostic test that
measures red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The
CBC includes a differential of the white blood cells. A CBC is often included as part of
routine health screening or to obtain information related to specific conditions. In mental
health, the CBC is used to rule out medical conditions that may present with symptoms
that can be attributed to both medical and psychiatric diagnoses. For example, the CBC
can help rule out anemia as a cause for depressive symptoms and fatigue or rule out
infection as a cause of acute mental status changes. The CBC is also used to monitor
,certain treatment regimens. For example, some medications, such as clozapine, require
routine analysis of absolute neutrophil count and platelet levels.
Normal Range of:
Red blood cells
Hemoglobin
Hematocrit
Reticulocytes - CORRECT ANSWER Red blood cells: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
Normal Range of?
White blood cells (total):
Neutrophils:
Eosinophils:
Basophils:
Lymphocytes:
Monocytes:
Platelets: - CORRECT ANSWER White blood cells (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Comprehensive Metabolic Panel (CMP) - CORRECT ANSWER The CMP is another
common blood test used to determine general health status. The CMP includes several
tests that provide information about fluid and electrolyte balance as well as the status of
the body's metabolism, liver function, and kidney function. In psychiatric care, the CMP
may be used to rule out medical conditions that could cause symptoms such as
changes in mood or cognition. The CMP is also used to monitor the effects of
medications, such as antipsychotics, on liver function and glucose levels.
Normal CMP Levels
Electrolytes
Sodium (Na+):
Postassium (K+):
Chloride (Cl-):
Bicarbonate (HCO3-): - CORRECT ANSWER Normal CMP Levels
Electrolytes
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
, Normal CMP levels
Misc.
Calcium, serum (Ca 2+)
Glucose, serum Fasting:
2-h postprandial:
Cholesterol, serum:
Total Protein
Albumin - CORRECT ANSWER Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl;
2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
Kidney Tests
Creatinine, serum
Urea nitrogen, serum (BUN) - CORRECT ANSWER Creatinine, serum 0.6-1.2mg/dl
Urea nitrogen, serum (BUN) 7-18mg/dl
Liver Tests
Alanine aminotransferase (ALT), serum:
Aspartate aminotransferase (AST),
Bilirubin, serum (adult) Total//Direct:
Phosphatase (alkaline), serum: - CORRECT ANSWER Liver Tests
Alanine aminotransferase (ALT), serum: 8-20 U/L
Aspartate aminotransferase (AST), serum: 8-20 U/L
Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
Phosphatase (alkaline), serum: 20-70 U/L
Normal TFT levels
TSH:
T3:
T4: - CORRECT ANSWER Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
Vitamin B12 Level - CORRECT ANSWER Providers may choose to check vitamin B12
levels. Deficiency of vitamin B12 can affect mood and other brain functions. Common
psychiatric symptoms associated with B12 deficiency include depression, mania,
psychotic symptoms, and cognitive impairment (
A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-300/mL
indicates a borderline level with a possible need for additional testing.
EXAM QUESTIONS & DETAILED
CORRECT ANSWERS PASSED
Differential Dx - CORRECT ANSWER Diagnostic reasoning is the process of
questioning one's thinking to determine if all possible avenues have been explored and
if the conclusions that are drawn are based on evidence. This is a critical step for
providers who are trying to uncover a cause, or diagnosis, for their clients' signs and
symptoms. The provider's initial hypothesis is known as the differential diagnosis. The
differential diagnosis, or differential, is a working list of potential problems that can be
associated with the initial or chief complaint. Establishing a differential diagnosis is a
critical step in providing safe, quality care. This evolving process of clinical reasoning
and decision making involves examining the client's presentation, clinical data, and
when appropriate, screening and diagnostic test results to distinguish one disease from
another and arrive at the correct diagnosis. The Diagnostic and Statistical Manual of
Mental Disorders (DSM-5-TR)provides guidance for identifying psychiatric diagnosest
History of Present Illness - CORRECT ANSWER How long have you been feeling this
way?
Did something happen in your life that may have triggered these emotions?
How is this current situation impacting your life?
The Psychiatric History - CORRECT ANSWER Have you ever been hospitalized for
any mental health issues?
Have you ever had counseling or psychotherapy?
Have you ever taken medications for your mental health in the past?
Are you currently on any medications for mental health or sleep?
Medical History/Screening for General Medical Conditions - CORRECT ANSWER Do
you have a primary care provider?
Do you have any medical illnesses?
Are you currently taking any medications or herbal supplements?
Do you have any allergies to medications?
Have you ever been hospitalized for any reason?
Have you ever had surgery?
Family Psychiatric History - CORRECT ANSWER Has any relative of yours ever been
hospitalized for a mental health issue?
Has any blood relative of yours ever been diagnosed with a mental health issue?
Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
,Social and Developmental History - CORRECT ANSWER Tell me a little bit about your
childhood and how you grew up.
How was your experience in school when you were younger? Did you enjoy school?
How do you support yourself with your finances?
Do you have a good support system? Are you currently in a relationship? Where do you
live? Who do you live with?
What do you do in your free time? What activities do you enjoy?
Which of the following should be included when providing client education about
medication regimens? Select all that apply. - CORRECT ANSWER A)Explain how the
medication targets the symptoms, specific benefits, and expected time course. (Correct
answer)
B)Identify potential side effects, duration of side effects, and adverse effects. (Correct
answer)
C)Explain the instructions, dosing, and special requirements. (Correct answer)
D)Use teach-back methods to ensure client understanding. (Correct answer)
Apply the Ask Suicide-Screening Questions (ASQ) Suicide Risk Screening Tool (Links
to an external site.) to the scenario below.
A 52-year-old client presents to the emergency department following a car accident.
The emergency department (ED) physician is concerned that the client may have
intentionally crashed her car and requests a stat PMHNP consult. In speaking with the
PMHNP, the client describes persistent feelings of sadness and hopelessness. She
states that she often wonders if her husband would be happier if she wasn't around
anymore since she's never happy and sometimes thinks about what it would be like to
just take a handful of sleeping pills and go to sleep forever. The client reports a previous
suicide attempt when she was 16 but denies that she is considering killing herself right
now.
Based on the client's ASQ score, what is the most appropriate response?
A) No action is necessary as the client is not - CORRECT ANSWER B)Provide a brief
suicide safety assessment.
Rationale: While the client's responses do not indicate a need for a stat full safety and
mental health evaluation, the client requires a brief suicide safety assessment to
determine whether a full mental health evaluation in necessary. It is also important to
notify the client's physician or the clinician responsible for the client's care.
Complete Blood Count - CORRECT ANSWER The CBC is a serum diagnostic test that
measures red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The
CBC includes a differential of the white blood cells. A CBC is often included as part of
routine health screening or to obtain information related to specific conditions. In mental
health, the CBC is used to rule out medical conditions that may present with symptoms
that can be attributed to both medical and psychiatric diagnoses. For example, the CBC
can help rule out anemia as a cause for depressive symptoms and fatigue or rule out
infection as a cause of acute mental status changes. The CBC is also used to monitor
,certain treatment regimens. For example, some medications, such as clozapine, require
routine analysis of absolute neutrophil count and platelet levels.
Normal Range of:
Red blood cells
Hemoglobin
Hematocrit
Reticulocytes - CORRECT ANSWER Red blood cells: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
Normal Range of?
White blood cells (total):
Neutrophils:
Eosinophils:
Basophils:
Lymphocytes:
Monocytes:
Platelets: - CORRECT ANSWER White blood cells (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Comprehensive Metabolic Panel (CMP) - CORRECT ANSWER The CMP is another
common blood test used to determine general health status. The CMP includes several
tests that provide information about fluid and electrolyte balance as well as the status of
the body's metabolism, liver function, and kidney function. In psychiatric care, the CMP
may be used to rule out medical conditions that could cause symptoms such as
changes in mood or cognition. The CMP is also used to monitor the effects of
medications, such as antipsychotics, on liver function and glucose levels.
Normal CMP Levels
Electrolytes
Sodium (Na+):
Postassium (K+):
Chloride (Cl-):
Bicarbonate (HCO3-): - CORRECT ANSWER Normal CMP Levels
Electrolytes
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
, Normal CMP levels
Misc.
Calcium, serum (Ca 2+)
Glucose, serum Fasting:
2-h postprandial:
Cholesterol, serum:
Total Protein
Albumin - CORRECT ANSWER Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl;
2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
Kidney Tests
Creatinine, serum
Urea nitrogen, serum (BUN) - CORRECT ANSWER Creatinine, serum 0.6-1.2mg/dl
Urea nitrogen, serum (BUN) 7-18mg/dl
Liver Tests
Alanine aminotransferase (ALT), serum:
Aspartate aminotransferase (AST),
Bilirubin, serum (adult) Total//Direct:
Phosphatase (alkaline), serum: - CORRECT ANSWER Liver Tests
Alanine aminotransferase (ALT), serum: 8-20 U/L
Aspartate aminotransferase (AST), serum: 8-20 U/L
Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
Phosphatase (alkaline), serum: 20-70 U/L
Normal TFT levels
TSH:
T3:
T4: - CORRECT ANSWER Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
Vitamin B12 Level - CORRECT ANSWER Providers may choose to check vitamin B12
levels. Deficiency of vitamin B12 can affect mood and other brain functions. Common
psychiatric symptoms associated with B12 deficiency include depression, mania,
psychotic symptoms, and cognitive impairment (
A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-300/mL
indicates a borderline level with a possible need for additional testing.
