NR 547 Midterm Exam with Complete
Solutions
Differential Dx - ✔✔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 - ✔✔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?
Which of the following should be included when providing client education about medication
regimens? Select all that apply. - ✔✔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 - ✔✔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 - ✔✔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 - ✔✔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: - ✔✔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) - ✔✔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-): - ✔✔Normal CMP Levels
Electrolytes
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Solutions
Differential Dx - ✔✔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 - ✔✔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?
Which of the following should be included when providing client education about medication
regimens? Select all that apply. - ✔✔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 - ✔✔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 - ✔✔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 - ✔✔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: - ✔✔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) - ✔✔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-): - ✔✔Normal CMP Levels
Electrolytes
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
