WEEK 4 MIDTERM EXAM - NR547 - NR-547 (LATEST - 2026) DIFFERENTIAL
DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH ACROSS THE LIFESPAN
PRACTICUM - EXAM STUDYGUIDE QUESTIONS AND CORRECT ANSWERS
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. -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 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?
Answer:
Psychiatric assessment: History taking
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
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 PMHwith 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 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% Basophils: 0.5%-1% Lymphocytes: 20%-35%
Monocytes: 3%-8% Platelets: 150,000-300,000/microliter
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
• 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 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
Question:
12. Basic Laboratory Interpretation: Toxicology Screen
Answer:
-rule out substance use as a cause for symptoms -used before starting therapy involving
controlled substances -used to monitor medication adherence -used in the diagnosis of substance
use disorder
Question:
13. Basic Laboratory Interpretation: Urinalysis (UA)
Answer:
Urinary tract infections are associated with a variety of neuropsychiatric symptoms -acute mental
status changes
• UA may be used to rule out a UTI as the cause.
, Question:
14. Treat or Refer: Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L.
Answer:
Refer
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with fatigue. A
referral for treatment of hypothyroidism is required. Client can be reevaluated for fatigue if
symptoms persist after hypothyroid treatment has been initiated, TSH levels are within normal
limits.
Question:
15. Treat or Refer: Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL
and hematocrit is 42%. Terri is a 79-year old who presents with confusion. She has positive
urine leukocyte esterase.
Answer:
Begin treatment
Rationale: The hemoglobin and hematocrit are within normal limits. This client's complaint of
fatigue is not due to anemia. Begin treatment based on a complete evaluation.
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract infection
(UTI) , which may cause confusion. Refer this client for treatment of the UTI.
Question:
16. Treat or Refer: Julio is a 66-year-old who presents with depression. His vitamin D level 11
ng/mL.
Answer:
Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP may refer or
treat vitamin D deficiency depending on the level of comfort of the provider.
Question:
17. Treat or Refer: Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL.
Answer:
Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated
with anxiety symptoms. Client can be reevaluated for anxiety once hyperthyroid treatment has
been initiated and T3 levels are within normal limits.
Question:
18. Treat or Refer: Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is
900 picograms/mL.
Answer:
Begin treatment
Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis should be
initiated.
Question:
DIAGNOSIS IN PSYCHIATRIC-MENTAL HEALTH ACROSS THE LIFESPAN
PRACTICUM - EXAM STUDYGUIDE QUESTIONS AND CORRECT ANSWERS
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. -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 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?
Answer:
Psychiatric assessment: History taking
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
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 PMHwith 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 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% Basophils: 0.5%-1% Lymphocytes: 20%-35%
Monocytes: 3%-8% Platelets: 150,000-300,000/microliter
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
• 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 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
Question:
12. Basic Laboratory Interpretation: Toxicology Screen
Answer:
-rule out substance use as a cause for symptoms -used before starting therapy involving
controlled substances -used to monitor medication adherence -used in the diagnosis of substance
use disorder
Question:
13. Basic Laboratory Interpretation: Urinalysis (UA)
Answer:
Urinary tract infections are associated with a variety of neuropsychiatric symptoms -acute mental
status changes
• UA may be used to rule out a UTI as the cause.
, Question:
14. Treat or Refer: Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L.
Answer:
Refer
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with fatigue. A
referral for treatment of hypothyroidism is required. Client can be reevaluated for fatigue if
symptoms persist after hypothyroid treatment has been initiated, TSH levels are within normal
limits.
Question:
15. Treat or Refer: Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL
and hematocrit is 42%. Terri is a 79-year old who presents with confusion. She has positive
urine leukocyte esterase.
Answer:
Begin treatment
Rationale: The hemoglobin and hematocrit are within normal limits. This client's complaint of
fatigue is not due to anemia. Begin treatment based on a complete evaluation.
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract infection
(UTI) , which may cause confusion. Refer this client for treatment of the UTI.
Question:
16. Treat or Refer: Julio is a 66-year-old who presents with depression. His vitamin D level 11
ng/mL.
Answer:
Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP may refer or
treat vitamin D deficiency depending on the level of comfort of the provider.
Question:
17. Treat or Refer: Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL.
Answer:
Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated
with anxiety symptoms. Client can be reevaluated for anxiety once hyperthyroid treatment has
been initiated and T3 levels are within normal limits.
Question:
18. Treat or Refer: Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is
900 picograms/mL.
Answer:
Begin treatment
Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis should be
initiated.
Question:
