NR 547 DIFFERENTIAL DX MIDTERM
EXAM WITH COMPLETE SOLUTIONS
Differential xDx x- xcorrect xanswers x-Diagnostic xreasoning xis xthe xprocess xof
xquestioning xone's xthinking xto xdetermine xif xall xpossible xavenues xhave xbeen
xexplored xand xif xthe xconclusions xthat xare xdrawn xare xbased xon xevidence. xThis xis
xa xcritical xstep xfor xproviders xwho xare xtrying xto xuncover xa xcause, xor xdiagnosis,
xfor xtheir xclients' xsigns xand xsymptoms. xThe xprovider's xinitial xhypothesis xis xknown
xas xthe xdifferential xdiagnosis. xThe xdifferential xdiagnosis, xor xdifferential, xis xa
xworking xlist xof xpotential xproblems xthat xcan xbe xassociated xwith xthe xinitial xor xchief
xcomplaint. xEstablishing xa xdifferential xdiagnosis xis xa xcritical xstep xin xproviding
xsafe, xquality xcare. xThis xevolving xprocess xof xclinical xreasoning xand xdecision
xmaking xinvolves xexamining xthe xclient's xpresentation, xclinical xdata, xand xwhen
xappropriate, xscreening xand xdiagnostic xtest xresults xto xdistinguish xone xdisease
xfrom xanother xand xarrive xat xthe xcorrect xdiagnosis. xThe xDiagnostic xand xStatistical
xManual xof xMental xDisorders x(DSM-5-TR)provides xguidance xfor xidentifying
xpsychiatric xdiagnosest
History xof xPresent xIllness x- xcorrect xanswers x-How xlong xhave xyou xbeen xfeeling
xthis xway?
,Did xsomething xhappen xin xyour xlife xthat xmay xhave xtriggered xthese xemotions?
How xis xthis xcurrent xsituation ximpacting xyour xlife?
The xPsychiatric xHistory x- xcorrect xanswers x-Have xyou xever xbeen xhospitalized xfor
xany xmental xhealth xissues?
Have xyou xever xhad xcounseling xor xpsychotherapy?
Have xyou xever xtaken xmedications xfor xyour xmental xhealth xin xthe xpast?
Are xyou xcurrently xon xany xmedications xfor xmental xhealth xor xsleep?
Medical xHistory/Screening xfor xGeneral xMedical xConditions x- xcorrect xanswers x-Do
xyou xhave xa xprimary xcare xprovider?
Do xyou xhave xany xmedical xillnesses?
Are xyou xcurrently xtaking xany xmedications xor xherbal xsupplements?
Do xyou xhave xany xallergies xto xmedications?
Have xyou xever xbeen xhospitalized xfor xany xreason?
Have xyou xever xhad xsurgery?
Family xPsychiatric xHistory x- xcorrect xanswers x-Has xany xrelative xof xyours xever
xbeen xhospitalized xfor xa xmental xhealth xissue?
Has xany xblood xrelative xof xyours xever xbeen xdiagnosed xwith xa xmental xhealth
xissue?
Has xany xblood xrelative xof xyours xhad xa xhistory xof xseizures xor
xdementia/Alzheimer's?
Social xand xDevelopmental xHistory x- xcorrect xanswers x-Tell xme xa xlittle xbit xabout
xyour xchildhood xand xhow xyou xgrew xup.
How xwas xyour xexperience xin xschool xwhen xyou xwere xyounger? xDid xyou xenjoy
xschool?
How xdo xyou xsupport xyourself xwith xyour xfinances?
Do xyou xhave xa xgood xsupport xsystem? xAre xyou xcurrently xin xa xrelationship?
xWhere xdo xyou xlive? xWho xdo xyou xlive xwith?
What xdo xyou xdo xin xyour xfree xtime? xWhat xactivities xdo xyou xenjoy?
Which xof xthe xfollowing xshould xbe xincluded xwhen xproviding xclient xeducation xabout
xmedication xregimens? xSelect xall xthat xapply. x- xcorrect xanswers x-A)Explain xhow
xthe xmedication xtargets xthe xsymptoms, xspecific xbenefits, xand xexpected xtime
xcourse. x(Correct xanswer)
B)Identify xpotential xside xeffects, xduration xof xside xeffects, xand xadverse xeffects.
x(Correct xanswer)
C)Explain xthe xinstructions, xdosing, xand xspecial xrequirements. x(Correct xanswer)
D)Use xteach-back xmethods xto xensure xclient xunderstanding. x(Correct xanswer)
Apply xthe xAsk xSuicide-Screening xQuestions x(ASQ) xSuicide xRisk xScreening xTool
x(Links xto xan xexternal xsite.) xto xthe xscenario xbelow.
A x52-year-old xclient xpresents xto xthe xemergency xdepartment xfollowing xa xcar
xaccident. xThe xemergency xdepartment x(ED) xphysician xis xconcerned xthat xthe xclient
,xmay xhave xintentionally xcrashed xher xcar xand xrequests xa xstat xPMHNP xconsult. xIn
xspeaking xwith xthe xPMHNP, xthe xclient xdescribes xpersistent xfeelings xof xsadness
xand xhopelessness. xShe xstates xthat xshe xoften xwonders xif xher xhusband xwould xbe
xhappier xif xshe xwasn't xaround xanymore xsince xshe's xnever xhappy xand xsometimes
xthinks xabout xwhat xit xwould xbe xlike xto xjust xtake xa xhandful xof xsleeping xpills xand
xgo xto xsleep xforever. xThe xclient xreports xa xprevious xsuicide xattempt xwhen xshe
xwas x16 xbut xdenies xthat xshe xis xconsidering xkilling xherself xright xnow.
Based xon xthe xclient's xASQ xscore, xwhat xis xthe xmost xappropriate xresponse?
A) xNo xaction xis xnecessary xas xthe xclient xis xnot x- xcorrect xanswers x-B)Provide xa
xbrief xsuicide xsafety xassessment. x
Rationale: xWhile xthe xclient's xresponses xdo xnot xindicate xa xneed xfor xa xstat xfull
xsafety xand xmental xhealth xevaluation, xthe xclient xrequires xa xbrief xsuicide xsafety
xassessment xto xdetermine xwhether xa xfull xmental xhealth xevaluation xin xnecessary.
xIt xis xalso ximportant xto xnotify xthe xclient's xphysician xor xthe xclinician xresponsible
xfor xthe xclient's xcare.
Complete xBlood xCount x- xcorrect xanswers x-The xCBC xis xa xserum xdiagnostic xtest
xthat xmeasures xred xblood xcells, xwhite xblood xcells, xhemoglobin, xhematocrit, xand
xplatelets. xThe xCBC xincludes xa xdifferential xof xthe xwhite xblood xcells. xA xCBC xis
xoften xincluded xas xpart xof xroutine xhealth xscreening xor xto xobtain xinformation
xrelated xto xspecific xconditions. xIn xmental xhealth, xthe xCBC xis xused xto xrule xout
xmedical xconditions xthat xmay xpresent xwith xsymptoms xthat xcan xbe xattributed xto
xboth xmedical xand xpsychiatric xdiagnoses. xFor xexample, xthe xCBC xcan xhelp xrule
xout xanemia xas xa xcause xfor xdepressive xsymptoms xand xfatigue xor xrule xout
xinfection xas xa xcause xof xacute xmental xstatus xchanges. xThe xCBC xis xalso xused xto
xmonitor xcertain xtreatment xregimens. xFor xexample, xsome xmedications, xsuch xas
xclozapine, xrequire xroutine xanalysis xof xabsolute xneutrophil xcount xand xplatelet
xlevels.
Normal xRange xof: x
Red xblood xcells
Hemoglobin
Hematocrit
Reticulocytes x- xcorrect xanswers x-Red xblood xcells: x4.5-6.0 xmillion/microliter
Hemoglobin: x12-18 xgrams/100 xmL
Hematocrit: x38%-48%
Reticulocytes: x0%-1.5%
Normal xRange xof? x
White xblood xcells x(total): x
Neutrophils: x
Eosinophils: x
Basophils: x
Lymphocytes: x
Monocytes: x
, Platelets: x- xcorrect xanswers x-White xblood xcells x(total): x5000-10,000/microliter
Neutrophils: x55%-70%
Eosinophils: x1%-3%
Basophils: x0.5%-1%
Lymphocytes: x20%-35%
Monocytes: x3%-8%
Platelets: x150,000-300,000/microliter
Comprehensive xMetabolic xPanel x(CMP) x- xcorrect xanswers x-The xCMP xis xanother
xcommon xblood xtest xused xto xdetermine xgeneral xhealth xstatus. xThe xCMP xincludes
xseveral xtests xthat xprovide xinformation xabout xfluid xand xelectrolyte xbalance xas xwell
xas xthe xstatus xof xthe xbody's xmetabolism, xliver xfunction, xand xkidney xfunction. xIn
xpsychiatric xcare, xthe xCMP xmay xbe xused xto xrule xout xmedical xconditions xthat
xcould xcause xsymptoms xsuch xas xchanges xin xmood xor xcognition. xThe xCMP xis
xalso xused xto xmonitor xthe xeffects xof xmedications, xsuch xas xantipsychotics, xon
xliver xfunction xand xglucose xlevels.
Normal xCMP xLevels
Electrolytes
Sodium x(Na+): x
Postassium x(K+): x
Chloride x(Cl-): x
Bicarbonate x(HCO3-): x- xcorrect xanswers x-Normal xCMP xLevels
Electrolytes
Sodium x(Na+): x136-145 xmEq/L
Postassium x(K+): x3.5-5.0 xmEq/L
Chloride x(Cl-): x95-105 xmEq/L
Bicarbonate x(HCO3-): x22-28 xmEq/L
Normal xCMP xlevels
Misc. x
Calcium, xserum x(Ca x2+) x
Glucose, xserum xFasting: x
2-h xpostprandial: x
Cholesterol, xserum:
Total xProtein
Albumin x- xcorrect xanswers x-Calcium, xserum x(Ca x2+) x8.4-10.2 xmg/dl
Glucose, xserum xFasting: x70-110 xmg/dl;
x2-h xpostprandial: x<120mg/dl
Cholesterol, xserum: xREC<200 xmg/dl
Total xProtein x6.0-7.8 xg/dl
Albumin x3.5-5.5 xg/dl
Kidney xTests
Creatinine, xserum x
Urea xnitrogen, xserum x(BUN) x- xcorrect xanswers x-Creatinine, xserum x0.6-1.2mg/dl
EXAM WITH COMPLETE SOLUTIONS
Differential xDx x- xcorrect xanswers x-Diagnostic xreasoning xis xthe xprocess xof
xquestioning xone's xthinking xto xdetermine xif xall xpossible xavenues xhave xbeen
xexplored xand xif xthe xconclusions xthat xare xdrawn xare xbased xon xevidence. xThis xis
xa xcritical xstep xfor xproviders xwho xare xtrying xto xuncover xa xcause, xor xdiagnosis,
xfor xtheir xclients' xsigns xand xsymptoms. xThe xprovider's xinitial xhypothesis xis xknown
xas xthe xdifferential xdiagnosis. xThe xdifferential xdiagnosis, xor xdifferential, xis xa
xworking xlist xof xpotential xproblems xthat xcan xbe xassociated xwith xthe xinitial xor xchief
xcomplaint. xEstablishing xa xdifferential xdiagnosis xis xa xcritical xstep xin xproviding
xsafe, xquality xcare. xThis xevolving xprocess xof xclinical xreasoning xand xdecision
xmaking xinvolves xexamining xthe xclient's xpresentation, xclinical xdata, xand xwhen
xappropriate, xscreening xand xdiagnostic xtest xresults xto xdistinguish xone xdisease
xfrom xanother xand xarrive xat xthe xcorrect xdiagnosis. xThe xDiagnostic xand xStatistical
xManual xof xMental xDisorders x(DSM-5-TR)provides xguidance xfor xidentifying
xpsychiatric xdiagnosest
History xof xPresent xIllness x- xcorrect xanswers x-How xlong xhave xyou xbeen xfeeling
xthis xway?
,Did xsomething xhappen xin xyour xlife xthat xmay xhave xtriggered xthese xemotions?
How xis xthis xcurrent xsituation ximpacting xyour xlife?
The xPsychiatric xHistory x- xcorrect xanswers x-Have xyou xever xbeen xhospitalized xfor
xany xmental xhealth xissues?
Have xyou xever xhad xcounseling xor xpsychotherapy?
Have xyou xever xtaken xmedications xfor xyour xmental xhealth xin xthe xpast?
Are xyou xcurrently xon xany xmedications xfor xmental xhealth xor xsleep?
Medical xHistory/Screening xfor xGeneral xMedical xConditions x- xcorrect xanswers x-Do
xyou xhave xa xprimary xcare xprovider?
Do xyou xhave xany xmedical xillnesses?
Are xyou xcurrently xtaking xany xmedications xor xherbal xsupplements?
Do xyou xhave xany xallergies xto xmedications?
Have xyou xever xbeen xhospitalized xfor xany xreason?
Have xyou xever xhad xsurgery?
Family xPsychiatric xHistory x- xcorrect xanswers x-Has xany xrelative xof xyours xever
xbeen xhospitalized xfor xa xmental xhealth xissue?
Has xany xblood xrelative xof xyours xever xbeen xdiagnosed xwith xa xmental xhealth
xissue?
Has xany xblood xrelative xof xyours xhad xa xhistory xof xseizures xor
xdementia/Alzheimer's?
Social xand xDevelopmental xHistory x- xcorrect xanswers x-Tell xme xa xlittle xbit xabout
xyour xchildhood xand xhow xyou xgrew xup.
How xwas xyour xexperience xin xschool xwhen xyou xwere xyounger? xDid xyou xenjoy
xschool?
How xdo xyou xsupport xyourself xwith xyour xfinances?
Do xyou xhave xa xgood xsupport xsystem? xAre xyou xcurrently xin xa xrelationship?
xWhere xdo xyou xlive? xWho xdo xyou xlive xwith?
What xdo xyou xdo xin xyour xfree xtime? xWhat xactivities xdo xyou xenjoy?
Which xof xthe xfollowing xshould xbe xincluded xwhen xproviding xclient xeducation xabout
xmedication xregimens? xSelect xall xthat xapply. x- xcorrect xanswers x-A)Explain xhow
xthe xmedication xtargets xthe xsymptoms, xspecific xbenefits, xand xexpected xtime
xcourse. x(Correct xanswer)
B)Identify xpotential xside xeffects, xduration xof xside xeffects, xand xadverse xeffects.
x(Correct xanswer)
C)Explain xthe xinstructions, xdosing, xand xspecial xrequirements. x(Correct xanswer)
D)Use xteach-back xmethods xto xensure xclient xunderstanding. x(Correct xanswer)
Apply xthe xAsk xSuicide-Screening xQuestions x(ASQ) xSuicide xRisk xScreening xTool
x(Links xto xan xexternal xsite.) xto xthe xscenario xbelow.
A x52-year-old xclient xpresents xto xthe xemergency xdepartment xfollowing xa xcar
xaccident. xThe xemergency xdepartment x(ED) xphysician xis xconcerned xthat xthe xclient
,xmay xhave xintentionally xcrashed xher xcar xand xrequests xa xstat xPMHNP xconsult. xIn
xspeaking xwith xthe xPMHNP, xthe xclient xdescribes xpersistent xfeelings xof xsadness
xand xhopelessness. xShe xstates xthat xshe xoften xwonders xif xher xhusband xwould xbe
xhappier xif xshe xwasn't xaround xanymore xsince xshe's xnever xhappy xand xsometimes
xthinks xabout xwhat xit xwould xbe xlike xto xjust xtake xa xhandful xof xsleeping xpills xand
xgo xto xsleep xforever. xThe xclient xreports xa xprevious xsuicide xattempt xwhen xshe
xwas x16 xbut xdenies xthat xshe xis xconsidering xkilling xherself xright xnow.
Based xon xthe xclient's xASQ xscore, xwhat xis xthe xmost xappropriate xresponse?
A) xNo xaction xis xnecessary xas xthe xclient xis xnot x- xcorrect xanswers x-B)Provide xa
xbrief xsuicide xsafety xassessment. x
Rationale: xWhile xthe xclient's xresponses xdo xnot xindicate xa xneed xfor xa xstat xfull
xsafety xand xmental xhealth xevaluation, xthe xclient xrequires xa xbrief xsuicide xsafety
xassessment xto xdetermine xwhether xa xfull xmental xhealth xevaluation xin xnecessary.
xIt xis xalso ximportant xto xnotify xthe xclient's xphysician xor xthe xclinician xresponsible
xfor xthe xclient's xcare.
Complete xBlood xCount x- xcorrect xanswers x-The xCBC xis xa xserum xdiagnostic xtest
xthat xmeasures xred xblood xcells, xwhite xblood xcells, xhemoglobin, xhematocrit, xand
xplatelets. xThe xCBC xincludes xa xdifferential xof xthe xwhite xblood xcells. xA xCBC xis
xoften xincluded xas xpart xof xroutine xhealth xscreening xor xto xobtain xinformation
xrelated xto xspecific xconditions. xIn xmental xhealth, xthe xCBC xis xused xto xrule xout
xmedical xconditions xthat xmay xpresent xwith xsymptoms xthat xcan xbe xattributed xto
xboth xmedical xand xpsychiatric xdiagnoses. xFor xexample, xthe xCBC xcan xhelp xrule
xout xanemia xas xa xcause xfor xdepressive xsymptoms xand xfatigue xor xrule xout
xinfection xas xa xcause xof xacute xmental xstatus xchanges. xThe xCBC xis xalso xused xto
xmonitor xcertain xtreatment xregimens. xFor xexample, xsome xmedications, xsuch xas
xclozapine, xrequire xroutine xanalysis xof xabsolute xneutrophil xcount xand xplatelet
xlevels.
Normal xRange xof: x
Red xblood xcells
Hemoglobin
Hematocrit
Reticulocytes x- xcorrect xanswers x-Red xblood xcells: x4.5-6.0 xmillion/microliter
Hemoglobin: x12-18 xgrams/100 xmL
Hematocrit: x38%-48%
Reticulocytes: x0%-1.5%
Normal xRange xof? x
White xblood xcells x(total): x
Neutrophils: x
Eosinophils: x
Basophils: x
Lymphocytes: x
Monocytes: x
, Platelets: x- xcorrect xanswers x-White xblood xcells x(total): x5000-10,000/microliter
Neutrophils: x55%-70%
Eosinophils: x1%-3%
Basophils: x0.5%-1%
Lymphocytes: x20%-35%
Monocytes: x3%-8%
Platelets: x150,000-300,000/microliter
Comprehensive xMetabolic xPanel x(CMP) x- xcorrect xanswers x-The xCMP xis xanother
xcommon xblood xtest xused xto xdetermine xgeneral xhealth xstatus. xThe xCMP xincludes
xseveral xtests xthat xprovide xinformation xabout xfluid xand xelectrolyte xbalance xas xwell
xas xthe xstatus xof xthe xbody's xmetabolism, xliver xfunction, xand xkidney xfunction. xIn
xpsychiatric xcare, xthe xCMP xmay xbe xused xto xrule xout xmedical xconditions xthat
xcould xcause xsymptoms xsuch xas xchanges xin xmood xor xcognition. xThe xCMP xis
xalso xused xto xmonitor xthe xeffects xof xmedications, xsuch xas xantipsychotics, xon
xliver xfunction xand xglucose xlevels.
Normal xCMP xLevels
Electrolytes
Sodium x(Na+): x
Postassium x(K+): x
Chloride x(Cl-): x
Bicarbonate x(HCO3-): x- xcorrect xanswers x-Normal xCMP xLevels
Electrolytes
Sodium x(Na+): x136-145 xmEq/L
Postassium x(K+): x3.5-5.0 xmEq/L
Chloride x(Cl-): x95-105 xmEq/L
Bicarbonate x(HCO3-): x22-28 xmEq/L
Normal xCMP xlevels
Misc. x
Calcium, xserum x(Ca x2+) x
Glucose, xserum xFasting: x
2-h xpostprandial: x
Cholesterol, xserum:
Total xProtein
Albumin x- xcorrect xanswers x-Calcium, xserum x(Ca x2+) x8.4-10.2 xmg/dl
Glucose, xserum xFasting: x70-110 xmg/dl;
x2-h xpostprandial: x<120mg/dl
Cholesterol, xserum: xREC<200 xmg/dl
Total xProtein x6.0-7.8 xg/dl
Albumin x3.5-5.5 xg/dl
Kidney xTests
Creatinine, xserum x
Urea xnitrogen, xserum x(BUN) x- xcorrect xanswers x-Creatinine, xserum x0.6-1.2mg/dl
