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: Critical step in providing, safe, quality care. It helps discern
an accurate diagnosis; helps PMHNP gather useful responses to formulate and narrow the list of
potential diagnoses based on client’s s/s
2. Analysis of:
a) presenting symptoms: identify symptoms; ask length of time and any fluctuations in severity;
determine presence of stressors included identify factors that alleviate or exacerbate symptoms.
b) clinical data such as physical exam= must decide if medical, surgical, or neurological
condition is the cause of mental disorder; once determined that no disease process can be held
accountable, then the diagnosis of a mental health disorder can be made; knowledge and
understanding of physical s/s enables providers to recognize s/s that may indicate possible
medical or surgical illness
c) laboratory analysis. = vital in achieving goals of arriving at accurate diagnoses, identifying
medical comorbities, implementing appropriate treatment, and delivering cost effective care,
CBC, CMP, thyroid function tests, serum B12, vitamin D, toxicology, and UA.
d) Medical history including medications= includes treatments both past and present; past
surgeries should also be reviewed; essential to understand patient’s reaction to illnesses and
coping skills employed; important when determining potential causes of mental illness as well
as comorbid or confounding factors and may dictate possible treatment options or limitations;
Medical illness can precipitate a psychiatric disorder (ex. Anxiety in an individual recently
diagnosed with cancer); Medical illnesses can mimic a psychiatric disorder (ex.
Hyperthyroidism resembling an anxiety disorder); Medical illness can be precipitated by a
psychiatric disorder or its treatment (ex. a metabolic syndrome in a patient on a second-
generation antipsychotic medication); Medical illnesses can influence the choice of treatment
of a psychiatric disorder (ex. renal disorder and the use of lithium carbonate); pay special
attention to neurologic issues (seizures, head injury, pain disorder); know any hx of prenatal or
birthing problems or issues with developmental milestones; reproductive and mensgtrual
history is essential as well as a careful assessment of the potential for current or future
pregnancy
Medications: include all current psych meds and how long they have been used, compliance,
effects and any side effects; non-psych meds, OTC meds, sleep aids, herbal, and alternative meds
should also be reviewed; it is wise to advise patient should be asked to bring all medications to
interview, allergies to medications should also be assessed (including with medication and the
nature of the extent of and the treatment of the allergic response)
3. Evidence-based screening tools and psychiatric rating scales
a) Scoring????
b) Advantages and disadvantages: key role is to standardize the info collected across time and
by various observers; this standardization ensures consistent, comprehensive evaluation that
may aid treatment planning by establishing a diagnosis, ensuring a thorough description of
symptoms, identifying comorbid conditions, and characterizing other factors affecting
, treatment response. Also, the use of the rating scale can establish a baseline for follow-up of
the progression of an illness over time or in response to specific interventions. Helps to
monitor patients over time or for providing information that is more comprehensive that what
is generally obtained in a routine clinical interview; helps providers identify symptoms and
assess their severity and can assist with the evaluation of response to treatment; healthcare
administrators and payors are increasingly requiring standardized assessments to justify the
need for services or to assess the quality of care; Also used in research that informs the practice
of psychiatry; most rating scales also offer the user the advantages of a formal evaluation of the
measures performance characteristics. This allows the clinician to know to what extent a given
scale produces reproductible results (reliability) and how it compares to more definitive or
established ways of measuring the same thing (validity)
c) Components: WHO disability assessment schedule (WHODAS 2.0), Structured clinical
interview for DSM (SCID), Brief psychiatric rating scale (BPRS), Positive and Negative
syndrome scale (PANSS), Scale for the assessment of positive symptoms (SAPS) and scale for
the assessment of negative symptoms (SANS), Hamilton rating scale for depression (HAM-D),
Beck depression inventory (BDI), Hamilton Anxiety rating scale (HAM-A), Panic disorder
severity scale (PDSS), Clinician administered PTSD scale (CAPS), Yale brown obsessive
compulsive scale (YBOCS), Cage, Addiction severity index (ASI), Eating disorder
examination (EDE), Bulimia test revised (Bulit-R), Mini-mental state examination (MMSE),
Neuropsychiatric inventory (NPI), Score general intelligence test (SGIT), personality disorde4r
questionnaire (PDQ), Child behavior checklist (CBCL), Diagnostic interview schedule for
children (DISC), Conners rating scale Autism diagnostic interview-revised (ADI-R).
d) When to use (i.e., when is a brief screening tool inappropriate): are valuable in settings
where there may not be time or trained personnel to administer complex diagnostic interviews.
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:
Schizophrenia: disturbance lasting for months (at least 6) that significantly impairs functioning and that includes at
least 1 month of active phase psychotic symptoms
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- Hbg 12-18 grams/100ml/ hct: 38-48%/ plt 150,000-300,000/ml/ WBC 5k-10k
2.
CMP- NA 135-145/ K 3.5-5/ CL 95-105/ Bicarb 22-28/ Creatinine 0.6-1.2 BUN 7-18
3.
Thyroid function tests: TSH: 0.4-4.5 mlU/L T3:100-200 ng/dl T4: 5-11 ug/dl
4.
Vitamin B12 levels- psychiatric symptoms associated with B12 190-950, if 2-300 borderline and
additional testing possibly needed. Psychiatric symptoms associated with B12 deficiency include
depression, mania, psychotic symptoms, and cognitive impairment.
5. Vitamin D levels: 20-50 ng/mg. a level less than 12 ng/ml indicated a deficiency
4. Know terms
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: Critical step in providing, safe, quality care. It helps discern
an accurate diagnosis; helps PMHNP gather useful responses to formulate and narrow the list of
potential diagnoses based on client’s s/s
2. Analysis of:
a) presenting symptoms: identify symptoms; ask length of time and any fluctuations in severity;
determine presence of stressors included identify factors that alleviate or exacerbate symptoms.
b) clinical data such as physical exam= must decide if medical, surgical, or neurological
condition is the cause of mental disorder; once determined that no disease process can be held
accountable, then the diagnosis of a mental health disorder can be made; knowledge and
understanding of physical s/s enables providers to recognize s/s that may indicate possible
medical or surgical illness
c) laboratory analysis. = vital in achieving goals of arriving at accurate diagnoses, identifying
medical comorbities, implementing appropriate treatment, and delivering cost effective care,
CBC, CMP, thyroid function tests, serum B12, vitamin D, toxicology, and UA.
d) Medical history including medications= includes treatments both past and present; past
surgeries should also be reviewed; essential to understand patient’s reaction to illnesses and
coping skills employed; important when determining potential causes of mental illness as well
as comorbid or confounding factors and may dictate possible treatment options or limitations;
Medical illness can precipitate a psychiatric disorder (ex. Anxiety in an individual recently
diagnosed with cancer); Medical illnesses can mimic a psychiatric disorder (ex.
Hyperthyroidism resembling an anxiety disorder); Medical illness can be precipitated by a
psychiatric disorder or its treatment (ex. a metabolic syndrome in a patient on a second-
generation antipsychotic medication); Medical illnesses can influence the choice of treatment
of a psychiatric disorder (ex. renal disorder and the use of lithium carbonate); pay special
attention to neurologic issues (seizures, head injury, pain disorder); know any hx of prenatal or
birthing problems or issues with developmental milestones; reproductive and mensgtrual
history is essential as well as a careful assessment of the potential for current or future
pregnancy
Medications: include all current psych meds and how long they have been used, compliance,
effects and any side effects; non-psych meds, OTC meds, sleep aids, herbal, and alternative meds
should also be reviewed; it is wise to advise patient should be asked to bring all medications to
interview, allergies to medications should also be assessed (including with medication and the
nature of the extent of and the treatment of the allergic response)
3. Evidence-based screening tools and psychiatric rating scales
a) Scoring????
b) Advantages and disadvantages: key role is to standardize the info collected across time and
by various observers; this standardization ensures consistent, comprehensive evaluation that
may aid treatment planning by establishing a diagnosis, ensuring a thorough description of
symptoms, identifying comorbid conditions, and characterizing other factors affecting
, treatment response. Also, the use of the rating scale can establish a baseline for follow-up of
the progression of an illness over time or in response to specific interventions. Helps to
monitor patients over time or for providing information that is more comprehensive that what
is generally obtained in a routine clinical interview; helps providers identify symptoms and
assess their severity and can assist with the evaluation of response to treatment; healthcare
administrators and payors are increasingly requiring standardized assessments to justify the
need for services or to assess the quality of care; Also used in research that informs the practice
of psychiatry; most rating scales also offer the user the advantages of a formal evaluation of the
measures performance characteristics. This allows the clinician to know to what extent a given
scale produces reproductible results (reliability) and how it compares to more definitive or
established ways of measuring the same thing (validity)
c) Components: WHO disability assessment schedule (WHODAS 2.0), Structured clinical
interview for DSM (SCID), Brief psychiatric rating scale (BPRS), Positive and Negative
syndrome scale (PANSS), Scale for the assessment of positive symptoms (SAPS) and scale for
the assessment of negative symptoms (SANS), Hamilton rating scale for depression (HAM-D),
Beck depression inventory (BDI), Hamilton Anxiety rating scale (HAM-A), Panic disorder
severity scale (PDSS), Clinician administered PTSD scale (CAPS), Yale brown obsessive
compulsive scale (YBOCS), Cage, Addiction severity index (ASI), Eating disorder
examination (EDE), Bulimia test revised (Bulit-R), Mini-mental state examination (MMSE),
Neuropsychiatric inventory (NPI), Score general intelligence test (SGIT), personality disorde4r
questionnaire (PDQ), Child behavior checklist (CBCL), Diagnostic interview schedule for
children (DISC), Conners rating scale Autism diagnostic interview-revised (ADI-R).
d) When to use (i.e., when is a brief screening tool inappropriate): are valuable in settings
where there may not be time or trained personnel to administer complex diagnostic interviews.
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:
Schizophrenia: disturbance lasting for months (at least 6) that significantly impairs functioning and that includes at
least 1 month of active phase psychotic symptoms
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- Hbg 12-18 grams/100ml/ hct: 38-48%/ plt 150,000-300,000/ml/ WBC 5k-10k
2.
CMP- NA 135-145/ K 3.5-5/ CL 95-105/ Bicarb 22-28/ Creatinine 0.6-1.2 BUN 7-18
3.
Thyroid function tests: TSH: 0.4-4.5 mlU/L T3:100-200 ng/dl T4: 5-11 ug/dl
4.
Vitamin B12 levels- psychiatric symptoms associated with B12 190-950, if 2-300 borderline and
additional testing possibly needed. Psychiatric symptoms associated with B12 deficiency include
depression, mania, psychotic symptoms, and cognitive impairment.
5. Vitamin D levels: 20-50 ng/mg. a level less than 12 ng/ml indicated a deficiency
4. Know terms
