NR 547 MIDTERM EXAM Questions with Verified Answers
(Correct Update)
Question 1: differential diagnosis
Answer: 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
Question 2: Psychiatric assessment: History taking
Answer: -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 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?
Question 3: Screening and Psychiatric Rating Scales
Answer: 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
Page 1
,Question 4: 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?
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
Answer: 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.
Question 5: Diagnostic Testing when diagnosing mental health disorders
Answer: -Diagnostic tests and labs are most used to rule out physical conditions that may cause
psychiatric symptoms and to evaluate the effects of treatment
Question 6: Basic Laboratory Interpretation
Answer: Complete Blood Count Comprehensive Metabolic Panel (CMP) Thyroid Function Tests
Vitamin B12 Level Vitamin D Level Toxicology Screen Urinalysis (UA)
Question 7: Basic Laboratory Interpretation: Complete Blood Count
Answer: -measures RBCs, WBCs, hemoglobin, hematocrit, and platelets
-includes a differential 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 Neutrophils: 55%-70% Eosinophils: 1%-3% Basophils: 0.5%-1% Lymphocytes:
20%-35% Monocytes: 3%-8% Platelets: 150,000-300,000/microliter
Page 2
, Question 8: Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP)
Answer: common blood test used to determine general health status
-fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney function
-used to monitor the effects of medications, such as antipsychotics, on liver function and glucose levels
-rule out medical conditions that could cause symptoms
• Ex: changes in mood or cognition 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 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 0.6-1.2mg/dl
• Urea nitrogen, serum (BUN) 7-18mg/dl
-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
Question 9: Basic Laboratory Interpretation: Thyroid Function Tests (TFTs)
Answer: used to rule out thyroid disorders as a cause for symptoms
• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood swings, sleeping
difficulties, difficulties with concentration, short-term memory lapses, and lack of mental alertness
Normal TFT levels TSH: 0.4-4.5 mIU/L T3: 100-200 ng/dL T4: 5-11 ug/dL
Question 10: Basic Laboratory Interpretation: Vitamin B12 Level
Answer: Deficiency of vitamin B12 can affect mood and other brain functions
-psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms,
and cognitive impairment normal: 190-950 picograms/mL
• 200-300/mL indicates a borderline level with a possible need for additional testing
Question 11: Basic Laboratory Interpretation: Vitamin D Level
Answer: affects functions such as neurotransmission, neuroprotection, & neuroimmunomodulation
-high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia,
depression, seasonal affective disorder, and cognitive impairment
-Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain
development 25-hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a
deficiency
Page 3
(Correct Update)
Question 1: differential diagnosis
Answer: 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
Question 2: Psychiatric assessment: History taking
Answer: -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 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?
Question 3: Screening and Psychiatric Rating Scales
Answer: 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
Page 1
,Question 4: 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?
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
Answer: 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.
Question 5: Diagnostic Testing when diagnosing mental health disorders
Answer: -Diagnostic tests and labs are most used to rule out physical conditions that may cause
psychiatric symptoms and to evaluate the effects of treatment
Question 6: Basic Laboratory Interpretation
Answer: Complete Blood Count Comprehensive Metabolic Panel (CMP) Thyroid Function Tests
Vitamin B12 Level Vitamin D Level Toxicology Screen Urinalysis (UA)
Question 7: Basic Laboratory Interpretation: Complete Blood Count
Answer: -measures RBCs, WBCs, hemoglobin, hematocrit, and platelets
-includes a differential 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 Neutrophils: 55%-70% Eosinophils: 1%-3% Basophils: 0.5%-1% Lymphocytes:
20%-35% Monocytes: 3%-8% Platelets: 150,000-300,000/microliter
Page 2
, Question 8: Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP)
Answer: common blood test used to determine general health status
-fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney function
-used to monitor the effects of medications, such as antipsychotics, on liver function and glucose levels
-rule out medical conditions that could cause symptoms
• Ex: changes in mood or cognition 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 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 0.6-1.2mg/dl
• Urea nitrogen, serum (BUN) 7-18mg/dl
-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
Question 9: Basic Laboratory Interpretation: Thyroid Function Tests (TFTs)
Answer: used to rule out thyroid disorders as a cause for symptoms
• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood swings, sleeping
difficulties, difficulties with concentration, short-term memory lapses, and lack of mental alertness
Normal TFT levels TSH: 0.4-4.5 mIU/L T3: 100-200 ng/dL T4: 5-11 ug/dL
Question 10: Basic Laboratory Interpretation: Vitamin B12 Level
Answer: Deficiency of vitamin B12 can affect mood and other brain functions
-psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms,
and cognitive impairment normal: 190-950 picograms/mL
• 200-300/mL indicates a borderline level with a possible need for additional testing
Question 11: Basic Laboratory Interpretation: Vitamin D Level
Answer: affects functions such as neurotransmission, neuroprotection, & neuroimmunomodulation
-high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia,
depression, seasonal affective disorder, and cognitive impairment
-Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain
development 25-hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a
deficiency
Page 3
