NR 547 DIFFERENTIAL DX MIDTERM
EXAM GRADED A+
Differential bDx b- bcorrect banswers b-Diagnostic breasoning bis bthe bprocess bof
bquestioning bone's bthinking bto bdetermine bif ball bpossible bavenues bhave bbeen
bexplored band bif bthe bconclusions bthat bare bdrawn bare bbased bon bevidence. bThis
bis ba bcritical bstep bfor bproviders bwho bare btrying bto buncover ba bcause, bor
bdiagnosis, bfor btheir bclients' bsigns band bsymptoms. bThe bprovider's binitial
bhypothesis bis bknown bas bthe bdifferential bdiagnosis. bThe bdifferential bdiagnosis, bor
bdifferential, bis ba bworking blist bof bpotential bproblems bthat bcan bbe bassociated bwith
bthe binitial bor bchief bcomplaint. bEstablishing ba bdifferential bdiagnosis bis ba bcritical
bstep bin bproviding bsafe, bquality bcare. bThis bevolving bprocess bof bclinical breasoning
band bdecision bmaking binvolves bexamining bthe bclient's bpresentation, bclinical bdata,
band bwhen bappropriate, bscreening band bdiagnostic btest bresults bto bdistinguish bone
bdisease bfrom banother band barrive bat bthe bcorrect bdiagnosis. bThe bDiagnostic band
bStatistical bManual bof bMental bDisorders b(DSM-5-TR)provides bguidance bfor
bidentifying bpsychiatric bdiagnosest
History bof bPresent bIllness b- bcorrect banswers b-How blong bhave byou bbeen bfeeling
bthis bway?
,Did bsomething bhappen bin byour blife bthat bmay bhave btriggered bthese bemotions?
How bis bthis bcurrent bsituation bimpacting byour blife?
The bPsychiatric bHistory b- bcorrect banswers b-Have byou bever bbeen bhospitalized bfor
bany bmental bhealth bissues?
Have byou bever bhad bcounseling bor bpsychotherapy?
Have byou bever btaken bmedications bfor byour bmental bhealth bin bthe bpast?
Are byou bcurrently bon bany bmedications bfor bmental bhealth bor bsleep?
Medical bHistory/Screening bfor bGeneral bMedical bConditions b- bcorrect banswers b-Do
byou bhave ba bprimary bcare bprovider?
Do byou bhave bany bmedical billnesses?
Are byou bcurrently btaking bany bmedications bor bherbal bsupplements?
Do byou bhave bany ballergies bto bmedications?
Have byou bever bbeen bhospitalized bfor bany breason?
Have byou bever bhad bsurgery?
Family bPsychiatric bHistory b- bcorrect banswers b-Has bany brelative bof byours bever
bbeen bhospitalized bfor ba bmental bhealth bissue?
Has bany bblood brelative bof byours bever bbeen bdiagnosed bwith ba bmental bhealth
bissue?
Has bany bblood brelative bof byours bhad ba bhistory bof bseizures bor
bdementia/Alzheimer's?
Social band bDevelopmental bHistory b- bcorrect banswers b-Tell bme ba blittle bbit babout
byour bchildhood band bhow byou bgrew bup.
How bwas byour bexperience bin bschool bwhen byou bwere byounger? bDid byou benjoy
bschool?
How bdo byou bsupport byourself bwith byour bfinances?
Do byou bhave ba bgood bsupport bsystem? bAre byou bcurrently bin ba brelationship?
bWhere bdo byou blive? bWho bdo byou blive bwith?
What bdo byou bdo bin byour bfree btime? bWhat bactivities bdo byou benjoy?
Which bof bthe bfollowing bshould bbe bincluded bwhen bproviding bclient beducation
babout bmedication bregimens? bSelect ball bthat bapply. b- bcorrect banswers b-A)Explain
bhow bthe bmedication btargets bthe bsymptoms, bspecific bbenefits, band bexpected btime
bcourse. b(Correct banswer)
B)Identify bpotential bside beffects, bduration bof bside beffects, band badverse beffects.
b(Correct banswer)
C)Explain bthe binstructions, bdosing, band bspecial brequirements. b(Correct banswer)
D)Use bteach-back bmethods bto bensure bclient bunderstanding. b(Correct banswer)
Apply bthe bAsk bSuicide-Screening bQuestions b(ASQ) bSuicide bRisk bScreening bTool
b(Links bto ban bexternal bsite.) bto bthe bscenario bbelow.
A b52-year-old bclient bpresents bto bthe bemergency bdepartment bfollowing ba bcar
baccident. bThe bemergency bdepartment b(ED) bphysician bis bconcerned bthat bthe
,bclient bmay bhave bintentionally bcrashed bher bcar band brequests ba bstat bPMHNP
bconsult. bIn bspeaking bwith bthe bPMHNP, bthe bclient bdescribes bpersistent bfeelings
bof bsadness band bhopelessness. bShe bstates bthat bshe boften bwonders bif bher
bhusband bwould bbe bhappier bif bshe bwasn't baround banymore bsince bshe's bnever
bhappy band bsometimes bthinks babout bwhat bit bwould bbe blike bto bjust btake ba
bhandful bof bsleeping bpills band bgo bto bsleep bforever. bThe bclient breports ba
bprevious bsuicide battempt bwhen bshe bwas b16 bbut bdenies bthat bshe bis bconsidering
bkilling bherself bright bnow.
Based bon bthe bclient's bASQ bscore, bwhat bis bthe bmost bappropriate bresponse?
A) bNo baction bis bnecessary bas bthe bclient bis bnot b- bcorrect banswers b-B)Provide ba
bbrief bsuicide bsafety bassessment. b
Rationale: bWhile bthe bclient's bresponses bdo bnot bindicate ba bneed bfor ba bstat bfull
bsafety band bmental bhealth bevaluation, bthe bclient brequires ba bbrief bsuicide bsafety
bassessment bto bdetermine bwhether ba bfull bmental bhealth bevaluation bin bnecessary.
bIt bis balso bimportant bto bnotify bthe bclient's bphysician bor bthe bclinician bresponsible
bfor bthe bclient's bcare.
Complete bBlood bCount b- bcorrect banswers b-The bCBC bis ba bserum bdiagnostic btest
bthat bmeasures bred bblood bcells, bwhite bblood bcells, bhemoglobin, bhematocrit, band
bplatelets. bThe bCBC bincludes ba bdifferential bof bthe bwhite bblood bcells. bA bCBC bis
boften bincluded bas bpart bof broutine bhealth bscreening bor bto bobtain binformation
brelated bto bspecific bconditions. bIn bmental bhealth, bthe bCBC bis bused bto brule bout
bmedical bconditions bthat bmay bpresent bwith bsymptoms bthat bcan bbe battributed bto
bboth bmedical band bpsychiatric bdiagnoses. bFor bexample, bthe bCBC bcan bhelp brule
bout banemia bas ba bcause bfor bdepressive bsymptoms band bfatigue bor brule bout
binfection bas ba bcause bof bacute bmental bstatus bchanges. bThe bCBC bis balso bused
bto bmonitor bcertain btreatment bregimens. bFor bexample, bsome bmedications, bsuch
bas bclozapine, brequire broutine banalysis bof babsolute bneutrophil bcount band bplatelet
blevels.
Normal bRange bof: b
Red bblood bcells
Hemoglobin
Hematocrit
Reticulocytes b- bcorrect banswers b-Red bblood bcells: b4.5-6.0 bmillion/microliter
Hemoglobin: b12-18 bgrams/100 bmL
Hematocrit: b38%-48%
Reticulocytes: b0%-1.5%
Normal bRange bof? b
White bblood bcells b(total): b
Neutrophils: b
Eosinophils: b
Basophils: b
Lymphocytes: b
, Monocytes: b
Platelets: b- bcorrect banswers b-White bblood bcells b(total): b5000-10,000/microliter
Neutrophils: b55%-70%
Eosinophils: b1%-3%
Basophils: b0.5%-1%
Lymphocytes: b20%-35%
Monocytes: b3%-8%
Platelets: b150,000-300,000/microliter
Comprehensive bMetabolic bPanel b(CMP) b- bcorrect banswers b-The bCMP bis banother
bcommon bblood btest bused bto bdetermine bgeneral bhealth bstatus. bThe bCMP
bincludes bseveral btests bthat bprovide binformation babout bfluid band belectrolyte
bbalance bas bwell bas bthe bstatus bof bthe bbody's bmetabolism, bliver bfunction, band
bkidney bfunction. bIn bpsychiatric bcare, bthe bCMP bmay bbe bused bto brule bout
bmedical bconditions bthat bcould bcause bsymptoms bsuch bas bchanges bin bmood bor
bcognition. bThe bCMP bis balso bused bto bmonitor bthe beffects bof bmedications, bsuch
bas bantipsychotics, bon bliver bfunction band bglucose blevels.
Normal bCMP bLevels
Electrolytes
Sodium b(Na+): b
Postassium b(K+): b
Chloride b(Cl-): b
Bicarbonate b(HCO3-): b- bcorrect banswers b-Normal bCMP bLevels
Electrolytes
Sodium b(Na+): b136-145 bmEq/L
Postassium b(K+): b3.5-5.0 bmEq/L
Chloride b(Cl-): b95-105 bmEq/L
Bicarbonate b(HCO3-): b22-28 bmEq/L
Normal bCMP blevels
Misc. b
Calcium, bserum b(Ca b2+) b
Glucose, bserum bFasting: b
2-h bpostprandial: b
Cholesterol, bserum:
Total bProtein
Albumin b- bcorrect banswers b-Calcium, bserum b(Ca b2+) b8.4-10.2 bmg/dl
Glucose, bserum bFasting: b70-110 bmg/dl;
b2-h bpostprandial: b<120mg/dl
Cholesterol, bserum: bREC<200 bmg/dl
Total bProtein b6.0-7.8 bg/dl
Albumin b3.5-5.5 bg/dl
Kidney bTests
Creatinine, bserum b
EXAM GRADED A+
Differential bDx b- bcorrect banswers b-Diagnostic breasoning bis bthe bprocess bof
bquestioning bone's bthinking bto bdetermine bif ball bpossible bavenues bhave bbeen
bexplored band bif bthe bconclusions bthat bare bdrawn bare bbased bon bevidence. bThis
bis ba bcritical bstep bfor bproviders bwho bare btrying bto buncover ba bcause, bor
bdiagnosis, bfor btheir bclients' bsigns band bsymptoms. bThe bprovider's binitial
bhypothesis bis bknown bas bthe bdifferential bdiagnosis. bThe bdifferential bdiagnosis, bor
bdifferential, bis ba bworking blist bof bpotential bproblems bthat bcan bbe bassociated bwith
bthe binitial bor bchief bcomplaint. bEstablishing ba bdifferential bdiagnosis bis ba bcritical
bstep bin bproviding bsafe, bquality bcare. bThis bevolving bprocess bof bclinical breasoning
band bdecision bmaking binvolves bexamining bthe bclient's bpresentation, bclinical bdata,
band bwhen bappropriate, bscreening band bdiagnostic btest bresults bto bdistinguish bone
bdisease bfrom banother band barrive bat bthe bcorrect bdiagnosis. bThe bDiagnostic band
bStatistical bManual bof bMental bDisorders b(DSM-5-TR)provides bguidance bfor
bidentifying bpsychiatric bdiagnosest
History bof bPresent bIllness b- bcorrect banswers b-How blong bhave byou bbeen bfeeling
bthis bway?
,Did bsomething bhappen bin byour blife bthat bmay bhave btriggered bthese bemotions?
How bis bthis bcurrent bsituation bimpacting byour blife?
The bPsychiatric bHistory b- bcorrect banswers b-Have byou bever bbeen bhospitalized bfor
bany bmental bhealth bissues?
Have byou bever bhad bcounseling bor bpsychotherapy?
Have byou bever btaken bmedications bfor byour bmental bhealth bin bthe bpast?
Are byou bcurrently bon bany bmedications bfor bmental bhealth bor bsleep?
Medical bHistory/Screening bfor bGeneral bMedical bConditions b- bcorrect banswers b-Do
byou bhave ba bprimary bcare bprovider?
Do byou bhave bany bmedical billnesses?
Are byou bcurrently btaking bany bmedications bor bherbal bsupplements?
Do byou bhave bany ballergies bto bmedications?
Have byou bever bbeen bhospitalized bfor bany breason?
Have byou bever bhad bsurgery?
Family bPsychiatric bHistory b- bcorrect banswers b-Has bany brelative bof byours bever
bbeen bhospitalized bfor ba bmental bhealth bissue?
Has bany bblood brelative bof byours bever bbeen bdiagnosed bwith ba bmental bhealth
bissue?
Has bany bblood brelative bof byours bhad ba bhistory bof bseizures bor
bdementia/Alzheimer's?
Social band bDevelopmental bHistory b- bcorrect banswers b-Tell bme ba blittle bbit babout
byour bchildhood band bhow byou bgrew bup.
How bwas byour bexperience bin bschool bwhen byou bwere byounger? bDid byou benjoy
bschool?
How bdo byou bsupport byourself bwith byour bfinances?
Do byou bhave ba bgood bsupport bsystem? bAre byou bcurrently bin ba brelationship?
bWhere bdo byou blive? bWho bdo byou blive bwith?
What bdo byou bdo bin byour bfree btime? bWhat bactivities bdo byou benjoy?
Which bof bthe bfollowing bshould bbe bincluded bwhen bproviding bclient beducation
babout bmedication bregimens? bSelect ball bthat bapply. b- bcorrect banswers b-A)Explain
bhow bthe bmedication btargets bthe bsymptoms, bspecific bbenefits, band bexpected btime
bcourse. b(Correct banswer)
B)Identify bpotential bside beffects, bduration bof bside beffects, band badverse beffects.
b(Correct banswer)
C)Explain bthe binstructions, bdosing, band bspecial brequirements. b(Correct banswer)
D)Use bteach-back bmethods bto bensure bclient bunderstanding. b(Correct banswer)
Apply bthe bAsk bSuicide-Screening bQuestions b(ASQ) bSuicide bRisk bScreening bTool
b(Links bto ban bexternal bsite.) bto bthe bscenario bbelow.
A b52-year-old bclient bpresents bto bthe bemergency bdepartment bfollowing ba bcar
baccident. bThe bemergency bdepartment b(ED) bphysician bis bconcerned bthat bthe
,bclient bmay bhave bintentionally bcrashed bher bcar band brequests ba bstat bPMHNP
bconsult. bIn bspeaking bwith bthe bPMHNP, bthe bclient bdescribes bpersistent bfeelings
bof bsadness band bhopelessness. bShe bstates bthat bshe boften bwonders bif bher
bhusband bwould bbe bhappier bif bshe bwasn't baround banymore bsince bshe's bnever
bhappy band bsometimes bthinks babout bwhat bit bwould bbe blike bto bjust btake ba
bhandful bof bsleeping bpills band bgo bto bsleep bforever. bThe bclient breports ba
bprevious bsuicide battempt bwhen bshe bwas b16 bbut bdenies bthat bshe bis bconsidering
bkilling bherself bright bnow.
Based bon bthe bclient's bASQ bscore, bwhat bis bthe bmost bappropriate bresponse?
A) bNo baction bis bnecessary bas bthe bclient bis bnot b- bcorrect banswers b-B)Provide ba
bbrief bsuicide bsafety bassessment. b
Rationale: bWhile bthe bclient's bresponses bdo bnot bindicate ba bneed bfor ba bstat bfull
bsafety band bmental bhealth bevaluation, bthe bclient brequires ba bbrief bsuicide bsafety
bassessment bto bdetermine bwhether ba bfull bmental bhealth bevaluation bin bnecessary.
bIt bis balso bimportant bto bnotify bthe bclient's bphysician bor bthe bclinician bresponsible
bfor bthe bclient's bcare.
Complete bBlood bCount b- bcorrect banswers b-The bCBC bis ba bserum bdiagnostic btest
bthat bmeasures bred bblood bcells, bwhite bblood bcells, bhemoglobin, bhematocrit, band
bplatelets. bThe bCBC bincludes ba bdifferential bof bthe bwhite bblood bcells. bA bCBC bis
boften bincluded bas bpart bof broutine bhealth bscreening bor bto bobtain binformation
brelated bto bspecific bconditions. bIn bmental bhealth, bthe bCBC bis bused bto brule bout
bmedical bconditions bthat bmay bpresent bwith bsymptoms bthat bcan bbe battributed bto
bboth bmedical band bpsychiatric bdiagnoses. bFor bexample, bthe bCBC bcan bhelp brule
bout banemia bas ba bcause bfor bdepressive bsymptoms band bfatigue bor brule bout
binfection bas ba bcause bof bacute bmental bstatus bchanges. bThe bCBC bis balso bused
bto bmonitor bcertain btreatment bregimens. bFor bexample, bsome bmedications, bsuch
bas bclozapine, brequire broutine banalysis bof babsolute bneutrophil bcount band bplatelet
blevels.
Normal bRange bof: b
Red bblood bcells
Hemoglobin
Hematocrit
Reticulocytes b- bcorrect banswers b-Red bblood bcells: b4.5-6.0 bmillion/microliter
Hemoglobin: b12-18 bgrams/100 bmL
Hematocrit: b38%-48%
Reticulocytes: b0%-1.5%
Normal bRange bof? b
White bblood bcells b(total): b
Neutrophils: b
Eosinophils: b
Basophils: b
Lymphocytes: b
, Monocytes: b
Platelets: b- bcorrect banswers b-White bblood bcells b(total): b5000-10,000/microliter
Neutrophils: b55%-70%
Eosinophils: b1%-3%
Basophils: b0.5%-1%
Lymphocytes: b20%-35%
Monocytes: b3%-8%
Platelets: b150,000-300,000/microliter
Comprehensive bMetabolic bPanel b(CMP) b- bcorrect banswers b-The bCMP bis banother
bcommon bblood btest bused bto bdetermine bgeneral bhealth bstatus. bThe bCMP
bincludes bseveral btests bthat bprovide binformation babout bfluid band belectrolyte
bbalance bas bwell bas bthe bstatus bof bthe bbody's bmetabolism, bliver bfunction, band
bkidney bfunction. bIn bpsychiatric bcare, bthe bCMP bmay bbe bused bto brule bout
bmedical bconditions bthat bcould bcause bsymptoms bsuch bas bchanges bin bmood bor
bcognition. bThe bCMP bis balso bused bto bmonitor bthe beffects bof bmedications, bsuch
bas bantipsychotics, bon bliver bfunction band bglucose blevels.
Normal bCMP bLevels
Electrolytes
Sodium b(Na+): b
Postassium b(K+): b
Chloride b(Cl-): b
Bicarbonate b(HCO3-): b- bcorrect banswers b-Normal bCMP bLevels
Electrolytes
Sodium b(Na+): b136-145 bmEq/L
Postassium b(K+): b3.5-5.0 bmEq/L
Chloride b(Cl-): b95-105 bmEq/L
Bicarbonate b(HCO3-): b22-28 bmEq/L
Normal bCMP blevels
Misc. b
Calcium, bserum b(Ca b2+) b
Glucose, bserum bFasting: b
2-h bpostprandial: b
Cholesterol, bserum:
Total bProtein
Albumin b- bcorrect banswers b-Calcium, bserum b(Ca b2+) b8.4-10.2 bmg/dl
Glucose, bserum bFasting: b70-110 bmg/dl;
b2-h bpostprandial: b<120mg/dl
Cholesterol, bserum: bREC<200 bmg/dl
Total bProtein b6.0-7.8 bg/dl
Albumin b3.5-5.5 bg/dl
Kidney bTests
Creatinine, bserum b
