NR 547 Midterm Exam Questions and
Answers
1. differential diagnosis: The provider's initial hypothesis
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
2. Psychiatric assessment: History taking: -History of Present Illness
-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
-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
-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
-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
-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?
3. Screening and Psychiatric Rating Scales: Evidence-based screening tools and
psychiatric rating scales
-can help the provider identify symptoms and assess their severity and can assist with the evaluation of
response to treatment
,4. A 52-year-old client presents to the emergency department
following a car ac- cident. 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?
No action is necessary as the client is not currently considering
suicide. Provide a brief suicide safety assessment.
Alert the client's primary care
physician. Provide a ST: 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.
, 5. Diagnostic Testing when diagnosing mental health disorders: -
Diagnostic tests and labs are most used to rule out physical conditions that may cause psychiatric
symptoms and to evaluate the ettects of treatment
6. Basic Laboratory Interpretation: Complete
Blood Count Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
7. Basic Laboratory Interpretation: Complete Blood Count: -measures RBCs,
WBCs, hemo- globin, hematocrit, and platelets
-includes a ditterential of the WBCs
-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
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Answers
1. differential diagnosis: The provider's initial hypothesis
-a working list of potential problems that can be associated with the initial or chief complaint
-Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)
• provides guidance for identifying psychiatric diagnoses
2. Psychiatric assessment: History taking: -History of Present Illness
-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
-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
-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
-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
-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?
3. Screening and Psychiatric Rating Scales: Evidence-based screening tools and
psychiatric rating scales
-can help the provider identify symptoms and assess their severity and can assist with the evaluation of
response to treatment
,4. A 52-year-old client presents to the emergency department
following a car ac- cident. 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?
No action is necessary as the client is not currently considering
suicide. Provide a brief suicide safety assessment.
Alert the client's primary care
physician. Provide a ST: 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.
, 5. Diagnostic Testing when diagnosing mental health disorders: -
Diagnostic tests and labs are most used to rule out physical conditions that may cause psychiatric
symptoms and to evaluate the ettects of treatment
6. Basic Laboratory Interpretation: Complete
Blood Count Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
Toxicology Screen
Urinalysis (UA)
7. Basic Laboratory Interpretation: Complete Blood Count: -measures RBCs,
WBCs, hemo- globin, hematocrit, and platelets
-includes a ditterential of the WBCs
-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
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
