NR 547 Differential Dx Midterm Exam
Questions and Answers
1. Differential Dx
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 diagnosis
2. History of Present Illness
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?
3. The Psychiatric History
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?
4. Medical History/Screening for General Medical Conditions
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?
5. Family Psychiatric History
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?
6. Social and Developmental History
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?
,7. 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)
8. 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 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?
A) No action is necessary as the client is not currently considering
suicide.
, B) Provide a brief suicide safety assessment.
C) Alert the client's primary care physician.
D) Provide a STAT safety and full mental health evaluation.
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.
9. Complete Blood Count
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.
10. Normal Range of
Red blood cells
Questions and Answers
1. Differential Dx
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 diagnosis
2. History of Present Illness
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?
3. The Psychiatric History
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?
4. Medical History/Screening for General Medical Conditions
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?
5. Family Psychiatric History
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?
6. Social and Developmental History
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?
,7. 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)
8. 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 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?
A) No action is necessary as the client is not currently considering
suicide.
, B) Provide a brief suicide safety assessment.
C) Alert the client's primary care physician.
D) Provide a STAT safety and full mental health evaluation.
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.
9. Complete Blood Count
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.
10. Normal Range of
Red blood cells
