NR547 MIDTERM EXAM WITH
COMPLETE SOLUTIONS
differential ndiagnosis n- ncorrect nanswers n-The nprovider's ninitial nhypothesis
-a nworking nlist nof npotential nproblems nthat ncan nbe nassociated nwith nthe ninitial nor
nchief ncomplaint
-Diagnostic nand nStatistical nManual nof nMental nDisorders n(DSM-5-TR)
• nprovides nguidance nfor nidentifying npsychiatric ndiagnoses
Psychiatric nassessment: nHistory ntaking n- ncorrect nanswers n--History nof nPresent
nIllness
-How nlong nhave nyou nbeen nfeeling nthis nway?
-Did nsomething nhappen nin nyour nlife nthat nmay nhave ntriggered nthese nemotions?
-How nis nthis ncurrent nsituation nimpacting nyour nlife?
The nPsychiatric nHistory
-Have nyou never nbeen nhospitalized nfor nany nmental nhealth nissues?
-Have nyou never nhad ncounseling nor npsychotherapy?
-Have nyou never ntaken nmedications nfor nyour nmental nhealth nin nthe npast?
-Are nyou ncurrently non nany nmedications nfor nmental nhealth nor nsleep?
,Medical nHistory/Screening nfor nGeneral nMedical nConditions
-Do nyou nhave na nprimary ncare nprovider?
-Do nyou nhave nany nmedical nillnesses?
-Are nyou ncurrently ntaking nany nmedications nor nherbal nsupplements?
-Do nyou nhave nany nallergies nto nmedications?
-Have nyou never nbeen nhospitalized nfor nany nreason?
-Have nyou never nhad nsurgery?
Family nPsychiatric nHistory
-Has nany nrelative nof nyours never nbeen nhospitalized nfor na nmental nhealth nissue?
-Has nany nblood nrelative nof nyours never nbeen ndiagnosed nwith na nmental nhealth
nissue?
-Has nany nblood nrelative nof nyours nhad na nhistory nof nseizures nor
ndementia/Alzheimer's?
Social nand nDevelopmental nHistory
-Tell nme na nlittle nbit nabout nyour nchildhood nand nhow nyou ngrew nup.
-How nwas nyour nexperience nin nschool nwhen nyou nwere nyounger? nDid nyou nenjoy
nschool?
-How ndo nyou nsupport nyourself nwith nyour nfinances?
-Do nyou nhave na ngood nsupport nsystem? nAre nyou ncurrently nin na nrelationship?
nWhere ndo nyou nlive? nWho ndo nyou nlive nwith?
-What ndo nyou ndo nin nyour nfree ntime? nWhat nactivities ndo nyou nenjoy?
Screening nand nPsychiatric nRating nScales n- ncorrect nanswers n-Evidence-based
nscreening ntools nand npsychiatric nrating nscales
-can nhelp nthe nprovider nidentify nsymptoms nand nassess ntheir nseverity nand ncan
nassist nwith nthe nevaluation nof nresponse nto ntreatment
A n52-year-old nclient npresents nto nthe nemergency ndepartment nfollowing na ncar
naccident. nThe nemergency ndepartment n(ED) nphysician nis nconcerned nthat nthe
nclient nmay nhave nintentionally ncrashed nher ncar nand nrequests na nstat nPMHNP
nconsult. nIn nspeaking nwith nthe nPMHNP, nthe nclient ndescribes npersistent nfeelings
nof nsadness nand nhopelessness. nShe nstates nthat nshe noften nwonders nif nher
nhusband nwould nbe nhappier nif nshe nwasn't naround nanymore nsince nshe's nnever
nhappy nand nsometimes nthinks nabout nwhat nit nwould nbe nlike nto njust ntake na
nhandful nof nsleeping npills nand ngo nto nsleep nforever. nThe nclient nreports na
nprevious nsuicide nattempt nwhen nshe nwas n16 nbut ndenies nthat nshe nis nconsidering
nkilling nherself nright nnow.
Based non nthe nclient's nASQ nscore, nwhat nis nthe nmost nappropriate nresponse?
No naction nis nnecessary nas nthe nclient nis nnot ncurrently nconsidering nsuicide.
Provide na nbrief nsuicide nsafety nassessment. n
Alert nthe nclient's nprimary ncare nphysician.
Provide na nST n- ncorrect nanswers n-Provide na nbrief nsuicide nsafety nassessment. n
,Rationale: nWhile nthe nclient's nresponses ndo nnot nindicate na nneed nfor na nstat nfull
nsafety nand nmental nhealth nevaluation, nthe nclient nrequires na nbrief nsuicide nsafety
nassessment nto ndetermine nwhether na nfull nmental nhealth nevaluation nin nnecessary.
nIt nis nalso nimportant nto nnotify nthe nclient's nphysician nor nthe nclinician nresponsible
nfor nthe nclient's ncare.
Diagnostic nTesting nwhen ndiagnosing nmental nhealth ndisorders n- ncorrect nanswers
n--Diagnostic ntests nand nlabs nare nmost nused nto nrule nout nphysical nconditions nthat
nmay ncause npsychiatric nsymptoms nand nto nevaluate nthe neffects nof ntreatment
Basic nLaboratory nInterpretation n- ncorrect nanswers n-Complete nBlood nCount
Comprehensive nMetabolic nPanel n(CMP)
Thyroid nFunction nTests
Vitamin nB12 nLevel
Vitamin nD nLevel
Toxicology nScreen
Urinalysis n(UA)
Basic nLaboratory nInterpretation: nComplete nBlood nCount n- ncorrect nanswers n--
measures nRBCs, nWBCs, nhemoglobin, nhematocrit, nand nplatelets
-includes na ndifferential nof nthe nWBCs
-In nmental nhealth, nthe nCBC nis nused nto nrule nout nmedical nconditions nthat nmay
npresent nwith nsymptoms nthat ncan nbe nattributed nto nboth nmedical nand npsychiatric
ndiagnoses
• nEx: nrule nout nanemia nas na ncause nfor ndepressive nsymptoms nand nfatigue
• nEx: nrule nout ninfection nas na ncause nof nacute nmental nstatus nchanges
RBCs: n4.5-6.0 nmillion/microliter
Hemoglobin: n12-18 ngrams/100 nmL
Hematocrit: n38%-48%
Reticulocytes: n0%-1.5%
WBCs n(total): n5000-10,000/microliter
Neutrophils: n55%-70%
Eosinophils: n1%-3%
Basophils: n0.5%-1%
Lymphocytes: n20%-35%
Monocytes: n3%-8%
Platelets: n150,000-300,000/microliter
Basic nLaboratory nInterpretation: nComprehensive nMetabolic nPanel n(CMP) n- ncorrect
nanswers n-common nblood ntest nused nto ndetermine ngeneral nhealth nstatus
-fluid nand nelectrolyte nbalance, nstatus nof nthe nbody's nmetabolism, nliver nfunction,
nand nkidney nfunction
-used nto nmonitor nthe neffects nof nmedications, nsuch nas nantipsychotics, non nliver
nfunction nand nglucose nlevels
-rule nout nmedical nconditions nthat ncould ncause nsymptoms
, • nEx: nchanges nin nmood nor ncognition
Sodium n(Na+): n136-145 nmEq/L
Postassium n(K+): n3.5-5.0 nmEq/L
Chloride n(Cl-): n95-105 nmEq/L
Bicarbonate n(HCO3-): n22-28 nmEq/L
Calcium, nserum n(Ca n2+) n8.4-10.2 nmg/dl
Glucose, nserum nFasting: n70-110 nmg/dl; n2-h npostprandial: n<120mg/dl
Cholesterol, nserum: nREC<200 nmg/dl
Total nProtein n6.0-7.8 ng/dl
Albumin n3.5-5.5 ng/dl
-Kidney nTests
• nCreatinine, nserum n0.6-1.2mg/dl
• nUrea nnitrogen, nserum n(BUN) n7-18mg/dl
-Liver nTests
• nAlanine naminotransferase n(ALT), nserum: n8-20 nU/L
• nAspartate naminotransferase n(AST), nserum: n8-20 nU/L
• nBilirubin, nserum n(adult) nTotal//Direct: n0.1-1.0 nmg/dl n// n0.0-0.3 nmg/dl
• nPhosphatase n(alkaline), nserum: n20-70 nU/L
Basic nLaboratory nInterpretation: nThyroid nFunction nTests n(TFTs) n- ncorrect nanswers
n-used nto nrule nout nthyroid ndisorders nas na ncause nfor nsymptoms
• nsymptoms nrelated nto nthyroid ndisorders ninclude nanxiety, nrestlessness,
ndepression, nmood nswings, nsleeping ndifficulties, ndifficulties nwith nconcentration,
nshort-term nmemory nlapses, nand nlack nof nmental nalertness
Normal nTFT nlevels
TSH: n0.4-4.5 nmIU/L
T3: n100-200 nng/dL
T4: n5-11 nug/dL
Basic nLaboratory nInterpretation: nVitamin nB12 nLevel n- ncorrect nanswers n-Deficiency
nof nvitamin nB12 ncan naffect nmood nand nother nbrain nfunctions
-psychiatric nsymptoms nassociated nwith nB12 ndeficiency ninclude ndepression, nmania,
npsychotic nsymptoms, nand ncognitive nimpairment
normal: n190-950 npicograms/mL
• n200-300/mL nindicates na nborderline nlevel nwith na npossible nneed nfor nadditional
ntesting
Basic nLaboratory nInterpretation: nVitamin nD nLevel n- ncorrect nanswers n-affects
nfunctions nsuch nas nneurotransmission, nneuroprotection, n& nneuroimmunomodulation
-high nprevalence nof nvitamin nD ndeficiency nin nclients nwith npsychiatric ndisorders
nsuch nas nschizophrenia, ndepression, nseasonal naffective ndisorder, nand ncognitive
nimpairment
COMPLETE SOLUTIONS
differential ndiagnosis n- ncorrect nanswers n-The nprovider's ninitial nhypothesis
-a nworking nlist nof npotential nproblems nthat ncan nbe nassociated nwith nthe ninitial nor
nchief ncomplaint
-Diagnostic nand nStatistical nManual nof nMental nDisorders n(DSM-5-TR)
• nprovides nguidance nfor nidentifying npsychiatric ndiagnoses
Psychiatric nassessment: nHistory ntaking n- ncorrect nanswers n--History nof nPresent
nIllness
-How nlong nhave nyou nbeen nfeeling nthis nway?
-Did nsomething nhappen nin nyour nlife nthat nmay nhave ntriggered nthese nemotions?
-How nis nthis ncurrent nsituation nimpacting nyour nlife?
The nPsychiatric nHistory
-Have nyou never nbeen nhospitalized nfor nany nmental nhealth nissues?
-Have nyou never nhad ncounseling nor npsychotherapy?
-Have nyou never ntaken nmedications nfor nyour nmental nhealth nin nthe npast?
-Are nyou ncurrently non nany nmedications nfor nmental nhealth nor nsleep?
,Medical nHistory/Screening nfor nGeneral nMedical nConditions
-Do nyou nhave na nprimary ncare nprovider?
-Do nyou nhave nany nmedical nillnesses?
-Are nyou ncurrently ntaking nany nmedications nor nherbal nsupplements?
-Do nyou nhave nany nallergies nto nmedications?
-Have nyou never nbeen nhospitalized nfor nany nreason?
-Have nyou never nhad nsurgery?
Family nPsychiatric nHistory
-Has nany nrelative nof nyours never nbeen nhospitalized nfor na nmental nhealth nissue?
-Has nany nblood nrelative nof nyours never nbeen ndiagnosed nwith na nmental nhealth
nissue?
-Has nany nblood nrelative nof nyours nhad na nhistory nof nseizures nor
ndementia/Alzheimer's?
Social nand nDevelopmental nHistory
-Tell nme na nlittle nbit nabout nyour nchildhood nand nhow nyou ngrew nup.
-How nwas nyour nexperience nin nschool nwhen nyou nwere nyounger? nDid nyou nenjoy
nschool?
-How ndo nyou nsupport nyourself nwith nyour nfinances?
-Do nyou nhave na ngood nsupport nsystem? nAre nyou ncurrently nin na nrelationship?
nWhere ndo nyou nlive? nWho ndo nyou nlive nwith?
-What ndo nyou ndo nin nyour nfree ntime? nWhat nactivities ndo nyou nenjoy?
Screening nand nPsychiatric nRating nScales n- ncorrect nanswers n-Evidence-based
nscreening ntools nand npsychiatric nrating nscales
-can nhelp nthe nprovider nidentify nsymptoms nand nassess ntheir nseverity nand ncan
nassist nwith nthe nevaluation nof nresponse nto ntreatment
A n52-year-old nclient npresents nto nthe nemergency ndepartment nfollowing na ncar
naccident. nThe nemergency ndepartment n(ED) nphysician nis nconcerned nthat nthe
nclient nmay nhave nintentionally ncrashed nher ncar nand nrequests na nstat nPMHNP
nconsult. nIn nspeaking nwith nthe nPMHNP, nthe nclient ndescribes npersistent nfeelings
nof nsadness nand nhopelessness. nShe nstates nthat nshe noften nwonders nif nher
nhusband nwould nbe nhappier nif nshe nwasn't naround nanymore nsince nshe's nnever
nhappy nand nsometimes nthinks nabout nwhat nit nwould nbe nlike nto njust ntake na
nhandful nof nsleeping npills nand ngo nto nsleep nforever. nThe nclient nreports na
nprevious nsuicide nattempt nwhen nshe nwas n16 nbut ndenies nthat nshe nis nconsidering
nkilling nherself nright nnow.
Based non nthe nclient's nASQ nscore, nwhat nis nthe nmost nappropriate nresponse?
No naction nis nnecessary nas nthe nclient nis nnot ncurrently nconsidering nsuicide.
Provide na nbrief nsuicide nsafety nassessment. n
Alert nthe nclient's nprimary ncare nphysician.
Provide na nST n- ncorrect nanswers n-Provide na nbrief nsuicide nsafety nassessment. n
,Rationale: nWhile nthe nclient's nresponses ndo nnot nindicate na nneed nfor na nstat nfull
nsafety nand nmental nhealth nevaluation, nthe nclient nrequires na nbrief nsuicide nsafety
nassessment nto ndetermine nwhether na nfull nmental nhealth nevaluation nin nnecessary.
nIt nis nalso nimportant nto nnotify nthe nclient's nphysician nor nthe nclinician nresponsible
nfor nthe nclient's ncare.
Diagnostic nTesting nwhen ndiagnosing nmental nhealth ndisorders n- ncorrect nanswers
n--Diagnostic ntests nand nlabs nare nmost nused nto nrule nout nphysical nconditions nthat
nmay ncause npsychiatric nsymptoms nand nto nevaluate nthe neffects nof ntreatment
Basic nLaboratory nInterpretation n- ncorrect nanswers n-Complete nBlood nCount
Comprehensive nMetabolic nPanel n(CMP)
Thyroid nFunction nTests
Vitamin nB12 nLevel
Vitamin nD nLevel
Toxicology nScreen
Urinalysis n(UA)
Basic nLaboratory nInterpretation: nComplete nBlood nCount n- ncorrect nanswers n--
measures nRBCs, nWBCs, nhemoglobin, nhematocrit, nand nplatelets
-includes na ndifferential nof nthe nWBCs
-In nmental nhealth, nthe nCBC nis nused nto nrule nout nmedical nconditions nthat nmay
npresent nwith nsymptoms nthat ncan nbe nattributed nto nboth nmedical nand npsychiatric
ndiagnoses
• nEx: nrule nout nanemia nas na ncause nfor ndepressive nsymptoms nand nfatigue
• nEx: nrule nout ninfection nas na ncause nof nacute nmental nstatus nchanges
RBCs: n4.5-6.0 nmillion/microliter
Hemoglobin: n12-18 ngrams/100 nmL
Hematocrit: n38%-48%
Reticulocytes: n0%-1.5%
WBCs n(total): n5000-10,000/microliter
Neutrophils: n55%-70%
Eosinophils: n1%-3%
Basophils: n0.5%-1%
Lymphocytes: n20%-35%
Monocytes: n3%-8%
Platelets: n150,000-300,000/microliter
Basic nLaboratory nInterpretation: nComprehensive nMetabolic nPanel n(CMP) n- ncorrect
nanswers n-common nblood ntest nused nto ndetermine ngeneral nhealth nstatus
-fluid nand nelectrolyte nbalance, nstatus nof nthe nbody's nmetabolism, nliver nfunction,
nand nkidney nfunction
-used nto nmonitor nthe neffects nof nmedications, nsuch nas nantipsychotics, non nliver
nfunction nand nglucose nlevels
-rule nout nmedical nconditions nthat ncould ncause nsymptoms
, • nEx: nchanges nin nmood nor ncognition
Sodium n(Na+): n136-145 nmEq/L
Postassium n(K+): n3.5-5.0 nmEq/L
Chloride n(Cl-): n95-105 nmEq/L
Bicarbonate n(HCO3-): n22-28 nmEq/L
Calcium, nserum n(Ca n2+) n8.4-10.2 nmg/dl
Glucose, nserum nFasting: n70-110 nmg/dl; n2-h npostprandial: n<120mg/dl
Cholesterol, nserum: nREC<200 nmg/dl
Total nProtein n6.0-7.8 ng/dl
Albumin n3.5-5.5 ng/dl
-Kidney nTests
• nCreatinine, nserum n0.6-1.2mg/dl
• nUrea nnitrogen, nserum n(BUN) n7-18mg/dl
-Liver nTests
• nAlanine naminotransferase n(ALT), nserum: n8-20 nU/L
• nAspartate naminotransferase n(AST), nserum: n8-20 nU/L
• nBilirubin, nserum n(adult) nTotal//Direct: n0.1-1.0 nmg/dl n// n0.0-0.3 nmg/dl
• nPhosphatase n(alkaline), nserum: n20-70 nU/L
Basic nLaboratory nInterpretation: nThyroid nFunction nTests n(TFTs) n- ncorrect nanswers
n-used nto nrule nout nthyroid ndisorders nas na ncause nfor nsymptoms
• nsymptoms nrelated nto nthyroid ndisorders ninclude nanxiety, nrestlessness,
ndepression, nmood nswings, nsleeping ndifficulties, ndifficulties nwith nconcentration,
nshort-term nmemory nlapses, nand nlack nof nmental nalertness
Normal nTFT nlevels
TSH: n0.4-4.5 nmIU/L
T3: n100-200 nng/dL
T4: n5-11 nug/dL
Basic nLaboratory nInterpretation: nVitamin nB12 nLevel n- ncorrect nanswers n-Deficiency
nof nvitamin nB12 ncan naffect nmood nand nother nbrain nfunctions
-psychiatric nsymptoms nassociated nwith nB12 ndeficiency ninclude ndepression, nmania,
npsychotic nsymptoms, nand ncognitive nimpairment
normal: n190-950 npicograms/mL
• n200-300/mL nindicates na nborderline nlevel nwith na npossible nneed nfor nadditional
ntesting
Basic nLaboratory nInterpretation: nVitamin nD nLevel n- ncorrect nanswers n-affects
nfunctions nsuch nas nneurotransmission, nneuroprotection, n& nneuroimmunomodulation
-high nprevalence nof nvitamin nD ndeficiency nin nclients nwith npsychiatric ndisorders
nsuch nas nschizophrenia, ndepression, nseasonal naffective ndisorder, nand ncognitive
nimpairment
