NR 547 Midterm Exam: NR 547 Midterm Study Guide:
75 Questions & Answers
Foundations of Differential Diagnosis, Anxiety Disorders, Psychoses, and Sleep-
Wake disorders.
Foundations & Clinical Data Interpretation
1. What is the initial hypothesis formulated by a provider trying to uncover
the cause of a client's signs and symptoms?
o A) Final Diagnosis
o B) Differential Diagnosis
o C) Treatment Plan
o D) Subjective History
o Answer: B. The provider's initial hypothesis is known as the
differential diagnosis; a working list of potential problems associated
with the chief complaint.
o Rationale: Establishing a differential is a critical step in clinical
reasoning to distinguish one disease from another based on
evidence.
2. Which of the following is a step in the "SNAPPS" method used for client
presentations?
o A) Skip the history
o B) Narrow the differential to two or three possibilities
, o C) Ignore preceptor feedback
o D) Finalize the diagnosis immediately
o Answer: B. The SNAPPS mnemonic includes narrowing the
differential as its second step.
o Rationale: SNAPPS stands for: Summarize, Narrow, Analyze, Probe,
Plan, and Select.
3. Toni, a 58-year-old, presents with fatigue and has a TSH of 6.3 mIU/L.
What is the most appropriate action?
o A) Start an SSRI for depression
o B) Refer for medical management of hypothyroidism
o C) Diagnose with GAD
o D) Reassure her it is normal aging
o Answer: B. A TSH level > 4.0 mIU/L is indicative of hypothyroidism.
o Rationale: Hypothyroidism is associated with fatigue; the client
should be treated for the medical condition and reevaluated for
psychiatric symptoms later.
4. A 79-year-old client presents with acute confusion and a positive urine
leukocyte esterase. What is the priority?
o A) Full psychiatric evaluation
o B) Refer for treatment of a Urinary Tract Infection (UTI)
o C) Start a low-dose antipsychotic
, o D) Diagnose with dementia
o Answer: B. Positive urine leukocyte esterase indicates a UTI, which
can cause confusion in older adults.
o Rationale: Rule out medical causes for mental status changes before
making a psychiatric diagnosis.
5. What is considered a normal range for Hemoglobin?
o A) 5-10 grams/100 mL
o B) 12-18 grams/100 mL
o C) 38-48 grams/100 mL
o D) 150-300 grams/100 mL
o Answer: B. The normal range is 12-18 g/100 mL.
o Rationale: Levels below this may indicate anemia, which can mimic
depressive symptoms and fatigue.
6. Which B12 level is considered borderline and may require additional
testing?
o A) 100-200 picograms/mL
o B) 200-300 picograms/mL
o C) 400-500 picograms/mL
o D) 900-950 picograms/mL
o Answer: B. Levels between 200-300 pg/mL are borderline.
, o Rationale: B12 deficiency is associated with depression, mania,
psychosis, and cognitive impairment.
7. A Vitamin D level less than which value indicates a deficiency?
o A) 30 ng/mL
o B) 20 ng/mL
o C) 12 ng/mL
o D) 50 ng/mL
o Answer: C. A level less than 12 ng/mL indicates deficiency.
o Rationale: Deficiency is linked to depression, irritability, and poor
brain development.
8. What is the normal range for Sodium (Na+)?
o A) 95-105 mEq/L
o B) 135-145 mEq/L
o C) 3.5-5.0 mEq/L
o D) 22-28 mEq/L
o Answer: B. Normal serum sodium is 135-145 mEq/L.
o Rationale: Electrolyte imbalances are monitored via the CMP to rule
out medical causes of mood or cognitive changes.
9. Which of the following is NOT a Social Determinant of Health (SDOH)?
o A) Food insecurity
75 Questions & Answers
Foundations of Differential Diagnosis, Anxiety Disorders, Psychoses, and Sleep-
Wake disorders.
Foundations & Clinical Data Interpretation
1. What is the initial hypothesis formulated by a provider trying to uncover
the cause of a client's signs and symptoms?
o A) Final Diagnosis
o B) Differential Diagnosis
o C) Treatment Plan
o D) Subjective History
o Answer: B. The provider's initial hypothesis is known as the
differential diagnosis; a working list of potential problems associated
with the chief complaint.
o Rationale: Establishing a differential is a critical step in clinical
reasoning to distinguish one disease from another based on
evidence.
2. Which of the following is a step in the "SNAPPS" method used for client
presentations?
o A) Skip the history
o B) Narrow the differential to two or three possibilities
, o C) Ignore preceptor feedback
o D) Finalize the diagnosis immediately
o Answer: B. The SNAPPS mnemonic includes narrowing the
differential as its second step.
o Rationale: SNAPPS stands for: Summarize, Narrow, Analyze, Probe,
Plan, and Select.
3. Toni, a 58-year-old, presents with fatigue and has a TSH of 6.3 mIU/L.
What is the most appropriate action?
o A) Start an SSRI for depression
o B) Refer for medical management of hypothyroidism
o C) Diagnose with GAD
o D) Reassure her it is normal aging
o Answer: B. A TSH level > 4.0 mIU/L is indicative of hypothyroidism.
o Rationale: Hypothyroidism is associated with fatigue; the client
should be treated for the medical condition and reevaluated for
psychiatric symptoms later.
4. A 79-year-old client presents with acute confusion and a positive urine
leukocyte esterase. What is the priority?
o A) Full psychiatric evaluation
o B) Refer for treatment of a Urinary Tract Infection (UTI)
o C) Start a low-dose antipsychotic
, o D) Diagnose with dementia
o Answer: B. Positive urine leukocyte esterase indicates a UTI, which
can cause confusion in older adults.
o Rationale: Rule out medical causes for mental status changes before
making a psychiatric diagnosis.
5. What is considered a normal range for Hemoglobin?
o A) 5-10 grams/100 mL
o B) 12-18 grams/100 mL
o C) 38-48 grams/100 mL
o D) 150-300 grams/100 mL
o Answer: B. The normal range is 12-18 g/100 mL.
o Rationale: Levels below this may indicate anemia, which can mimic
depressive symptoms and fatigue.
6. Which B12 level is considered borderline and may require additional
testing?
o A) 100-200 picograms/mL
o B) 200-300 picograms/mL
o C) 400-500 picograms/mL
o D) 900-950 picograms/mL
o Answer: B. Levels between 200-300 pg/mL are borderline.
, o Rationale: B12 deficiency is associated with depression, mania,
psychosis, and cognitive impairment.
7. A Vitamin D level less than which value indicates a deficiency?
o A) 30 ng/mL
o B) 20 ng/mL
o C) 12 ng/mL
o D) 50 ng/mL
o Answer: C. A level less than 12 ng/mL indicates deficiency.
o Rationale: Deficiency is linked to depression, irritability, and poor
brain development.
8. What is the normal range for Sodium (Na+)?
o A) 95-105 mEq/L
o B) 135-145 mEq/L
o C) 3.5-5.0 mEq/L
o D) 22-28 mEq/L
o Answer: B. Normal serum sodium is 135-145 mEq/L.
o Rationale: Electrolyte imbalances are monitored via the CMP to rule
out medical causes of mood or cognitive changes.
9. Which of the following is NOT a Social Determinant of Health (SDOH)?
o A) Food insecurity
