12/15/23, 8:31 PM Midterm Study Guide 547 September 2023
NR 547 MIDTERM STUDY GUIDE
The NR547 exam questions are taken from the Course
Activities, lectures, linked resources and required readings.
Mid-Term Exam: The Mid-Term has 75 questions worth two points each. You will have one
attempt to complete the exam with a time limit of 75 minutes.
Week 1: Foundations in Differential Diagnosis Formulation
1. The differential diagnosis:
1. Importance of the differential diagnosis
2. Analysis of:
a) presenting symptoms
b) clinical data such as physical exam
c) laboratory analysis.
d) Medical history including medications
3. Evidence-based screening tools and psychiatric rating scales
a) Scoring
b) Advantages and disadvantages
c) Components
d) When to use (i.e., when is a brief screening tool inappropriate)
4. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (American Psychiatric
Association [APA], 2022) criteria.
a) Know diagnostic criteria for various problems, such as Schizophrenia, sleep disorder, sexual
disorders and anxiety disorders
5. Rule out physical and substance-related causes for psychological symptoms.
6. Understand differences between the workup and treatment for new onset symptoms versus pre-
existing symptoms
a) New patients or new onset symptoms require full workup
b) Pre-existing conditions and diagnosis should be taken into account when formulating your
differentials
c) Pre-existing conditions may exclude some differentials
2. Social determinants of health and the psychiatric mental health nurse practitioners (PMHNPs) role in
addressing SDOH at the individual and population levels. SDOH have a significant impact on health, quality of
life, and life expectancy in relation to mental health. Social and environmental factors can influence genetic
determinants of health and illness and affect the risk for mental illness and substance use disorders.
3. Review basics of laboratory analysis including:
1. CBC
2. CMP
3. Thyroid function tests
4. Vitamin B12 levels
5. Vitamin D levels
4. Know terms
about:blank 1/25
,12/15/23, 8:31 PM Midterm Study Guide 547 September 2023
1. Alogia
2. Avolition
3. Anosognosia
4. Affective flattening
Week 2: Differential Diagnosis of Anxiety
1. Anxiety
a) GAD
1. Depression is a common comorbidity- What are ordinary worries for many people, patients
with a generalized anxiety disorder worry about them to the point where catastrophe seems
possible, likely, and imminent. Another feature is that these concerns cannot be prioritized or
put aside to deal with more pressing matters that may pop up. This inability to prioritize is a
key feature that contributes to the pathologic effect that this disorder has on functioning.
b) OCD - characterized by persistent, uncontrollable thoughts or actions that occur over an hour or
more per day, know comorbidities: Panic d/o, body dysmorphia, ADHD, tic d/o
1. Compulsions typically performed in response to an obsessive thought: Compulsions are
repetitive behaviors or mental acts that are done in response to obsessions, or in a rigid, rule-
bound way.
2. Subclinical versus clinical symptoms
c) Panic disorder – know diagnostic criteria and physiological symptoms: panic disorder, the anxiety is
related to the fear of having additional panic attacks and the possible consequences of these attacks.
Panic disorder is an acute intense attack of anxiety (a panic attack) accompanied by feelings of
impending doom. The anxiety occurs during discrete periods of intense fear that can vary from several
attacks during 1 day to only a few attacks during a year. Patients with panic disorder present with
several comorbid conditions, most commonly agoraphobia, which refers to a fear of or anxiety
regarding places from which escape might be difficult. Required number of symptoms 4 + panic
attacks or avoidance behavior or anticipatory anxiety for 1+ month. To be diagnosed with a panic
disorder, a patient must have recurrent, unexpected attacks. This requirement is to help distinguish the
disorder from the phobias and other possible causes of panic attacks.
d) Social phobias – know various phobias and diagnostic criteria: fear of social situations, including
situations that involve scrutiny or contact with strangers. Persons with social anxiety disorder are
fearful of embarrassing themselves in social situations (i.e., social gatherings, oral presentations,
meeting new people). They may have specific fears about performing specific activities such as eating
or speaking in front of others, or they may experience a vague, nonspecific fear of “embarrassing
oneself.” In either case, the fear in social anxiety disorder is of the embarrassment that may occur in the
situation, not the situation itself. Fear of being judged/scrutinized in social situation, Fear that others
will notice the anxiety, causing additional judgment, embarrassment, or rejection, Avoidance behaviors:
of the feared social situations, The fear/anxiety is out of proportion to the social risk, Fear of being
judged/scrutinized by others, Avoidance behaviors: of the feared social situations, May be associated
with low self-esteem, May cause panic attacks
e) Agoraphobia 6+ months– know definition and symptoms: Agoraphobia is similar in that the person is
afraid of places or situations that would be difficult or embarrassing to get out of in the event of a Panic
Attack or panic-like symptoms, but the focus is on the fear and avoidance of the places and situations
rather than on the Panic Attack itself. Agoraphobia requires that the individual must be fearful of
situations from at least two “agoraphobic clusters”: public transportation, open spaces, enclosed spaces,
standing in a line or being in a crowd, and being outside the home alone. It can be the most disabling of
the phobias because it can significantly interfere with a person’s ability to function in work and social
situations outside the home. Although agoraphobia often coexists with panic disorder, in that patients
are afraid to leave the safety of home lest they have a panic attack in a public place, DSM-5 considers
agoraphobia a separate condition that may or may not be comorbid with panic disorder. Often patients
with agoraphobia alone still have some measure of anxiety, “panic-like” symptoms, although those
symptoms may not reach the level of an actual panic attack. Patients with agoraphobia rigidly avoid
situations in which it would be challenging to obtain help. They prefer to be accompanied by a friend
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NR 547 MIDTERM STUDY GUIDE
The NR547 exam questions are taken from the Course
Activities, lectures, linked resources and required readings.
Mid-Term Exam: The Mid-Term has 75 questions worth two points each. You will have one
attempt to complete the exam with a time limit of 75 minutes.
Week 1: Foundations in Differential Diagnosis Formulation
1. The differential diagnosis:
1. Importance of the differential diagnosis
2. Analysis of:
a) presenting symptoms
b) clinical data such as physical exam
c) laboratory analysis.
d) Medical history including medications
3. Evidence-based screening tools and psychiatric rating scales
a) Scoring
b) Advantages and disadvantages
c) Components
d) When to use (i.e., when is a brief screening tool inappropriate)
4. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) (American Psychiatric
Association [APA], 2022) criteria.
a) Know diagnostic criteria for various problems, such as Schizophrenia, sleep disorder, sexual
disorders and anxiety disorders
5. Rule out physical and substance-related causes for psychological symptoms.
6. Understand differences between the workup and treatment for new onset symptoms versus pre-
existing symptoms
a) New patients or new onset symptoms require full workup
b) Pre-existing conditions and diagnosis should be taken into account when formulating your
differentials
c) Pre-existing conditions may exclude some differentials
2. Social determinants of health and the psychiatric mental health nurse practitioners (PMHNPs) role in
addressing SDOH at the individual and population levels. SDOH have a significant impact on health, quality of
life, and life expectancy in relation to mental health. Social and environmental factors can influence genetic
determinants of health and illness and affect the risk for mental illness and substance use disorders.
3. Review basics of laboratory analysis including:
1. CBC
2. CMP
3. Thyroid function tests
4. Vitamin B12 levels
5. Vitamin D levels
4. Know terms
about:blank 1/25
,12/15/23, 8:31 PM Midterm Study Guide 547 September 2023
1. Alogia
2. Avolition
3. Anosognosia
4. Affective flattening
Week 2: Differential Diagnosis of Anxiety
1. Anxiety
a) GAD
1. Depression is a common comorbidity- What are ordinary worries for many people, patients
with a generalized anxiety disorder worry about them to the point where catastrophe seems
possible, likely, and imminent. Another feature is that these concerns cannot be prioritized or
put aside to deal with more pressing matters that may pop up. This inability to prioritize is a
key feature that contributes to the pathologic effect that this disorder has on functioning.
b) OCD - characterized by persistent, uncontrollable thoughts or actions that occur over an hour or
more per day, know comorbidities: Panic d/o, body dysmorphia, ADHD, tic d/o
1. Compulsions typically performed in response to an obsessive thought: Compulsions are
repetitive behaviors or mental acts that are done in response to obsessions, or in a rigid, rule-
bound way.
2. Subclinical versus clinical symptoms
c) Panic disorder – know diagnostic criteria and physiological symptoms: panic disorder, the anxiety is
related to the fear of having additional panic attacks and the possible consequences of these attacks.
Panic disorder is an acute intense attack of anxiety (a panic attack) accompanied by feelings of
impending doom. The anxiety occurs during discrete periods of intense fear that can vary from several
attacks during 1 day to only a few attacks during a year. Patients with panic disorder present with
several comorbid conditions, most commonly agoraphobia, which refers to a fear of or anxiety
regarding places from which escape might be difficult. Required number of symptoms 4 + panic
attacks or avoidance behavior or anticipatory anxiety for 1+ month. To be diagnosed with a panic
disorder, a patient must have recurrent, unexpected attacks. This requirement is to help distinguish the
disorder from the phobias and other possible causes of panic attacks.
d) Social phobias – know various phobias and diagnostic criteria: fear of social situations, including
situations that involve scrutiny or contact with strangers. Persons with social anxiety disorder are
fearful of embarrassing themselves in social situations (i.e., social gatherings, oral presentations,
meeting new people). They may have specific fears about performing specific activities such as eating
or speaking in front of others, or they may experience a vague, nonspecific fear of “embarrassing
oneself.” In either case, the fear in social anxiety disorder is of the embarrassment that may occur in the
situation, not the situation itself. Fear of being judged/scrutinized in social situation, Fear that others
will notice the anxiety, causing additional judgment, embarrassment, or rejection, Avoidance behaviors:
of the feared social situations, The fear/anxiety is out of proportion to the social risk, Fear of being
judged/scrutinized by others, Avoidance behaviors: of the feared social situations, May be associated
with low self-esteem, May cause panic attacks
e) Agoraphobia 6+ months– know definition and symptoms: Agoraphobia is similar in that the person is
afraid of places or situations that would be difficult or embarrassing to get out of in the event of a Panic
Attack or panic-like symptoms, but the focus is on the fear and avoidance of the places and situations
rather than on the Panic Attack itself. Agoraphobia requires that the individual must be fearful of
situations from at least two “agoraphobic clusters”: public transportation, open spaces, enclosed spaces,
standing in a line or being in a crowd, and being outside the home alone. It can be the most disabling of
the phobias because it can significantly interfere with a person’s ability to function in work and social
situations outside the home. Although agoraphobia often coexists with panic disorder, in that patients
are afraid to leave the safety of home lest they have a panic attack in a public place, DSM-5 considers
agoraphobia a separate condition that may or may not be comorbid with panic disorder. Often patients
with agoraphobia alone still have some measure of anxiety, “panic-like” symptoms, although those
symptoms may not reach the level of an actual panic attack. Patients with agoraphobia rigidly avoid
situations in which it would be challenging to obtain help. They prefer to be accompanied by a friend
This is a preview
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, 12/15/23, 8:31 PM Midterm Study Guide 547 September 2023
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Premium and unlock all 19 pages
Access to all documents
Get Unlimited Downloads
Improve your grades
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Upload
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