NR547 Midterm Exam- NR 511 Midterm
[ACTUAL EXAM] LATEST VERSION
[QUESTIONS AND ANSWERS] WITH
PRACTICE EXAM DETAILED AND
VERIFIED FOR GUARANTEED PASS-
LATEST UPDATE 2025 GRADED A
A 52-year-old client presents to the emergency department following a car accident.
The emergency department (ED) physician is concerned that the client may have
intentionally crashed her car and requests a stat PMHNP consult. In speaking with the
PMHNP, the client describes persistent feelings of sadness and hopelessness. She
states that she often wonders if her husband would be happier if she wasn't around
anymore since she's never happy and sometimes thinks about what it would be like to
just take a handful of sleeping pills and go to sleep forever. The client reports a previous
suicide attempt when she was 16 but denies that she is considering killing herself right
now.
Based on the client's ASQ score, what is the most appropriate response?
No action is necessary as the client is not currently considering suicide.
Provide a brief suicide safety assessment.
Alert the client's primary care physician.
Provide a ST - CORRECT ANSWER Provide a brief suicide safety assessment.
Rationale: While the client's responses do not indicate a need for a stat full safety and
mental health evaluation, the client requires a brief suicide safety assessment to
determine whether a full mental health evaluation in necessary. It is also important to
notify the client's physician or the clinician responsible for the client's care.
Diagnostic Testing when diagnosing mental health disorders - CORRECT ANSWER -
Diagnostic tests and labs are most used to rule out physical conditions that may cause
psychiatric symptoms and to evaluate the effects of treatment
Basic Laboratory Interpretation - CORRECT ANSWER Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
,Toxicology Screen
Urinalysis (UA)
Basic Laboratory Interpretation: Complete Blood Count - CORRECT ANSWER -
measures RBCs, WBCs, hemoglobin, hematocrit, and platelets
-includes a differential of the WBCs
-In mental health, the CBC is used to rule out medical conditions that may present with
symptoms that can be attributed to both medical and psychiatric diagnoses
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP) - CORRECT
ANSWER common blood test used to determine general health status
-fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney
function
-used to monitor the effects of medications, such as antipsychotics, on liver function and
glucose levels
-rule out medical conditions that could cause symptoms
• Ex: changes in mood or cognition
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl; 2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
-Kidney Tests
• Creatinine, serum 0.6-1.2mg/dl
• Urea nitrogen, serum (BUN) 7-18mg/dl
-Liver Tests
• Alanine aminotransferase (ALT), serum: 8-20 U/L
,• Aspartate aminotransferase (AST), serum: 8-20 U/L
• Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
• Phosphatase (alkaline), serum: 20-70 U/L
Basic Laboratory Interpretation: Thyroid Function Tests (TFTs) - CORRECT ANSWER
used to rule out thyroid disorders as a cause for symptoms
• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood
swings, sleeping difficulties, difficulties with concentration, short-term memory lapses,
and lack of mental alertness
Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
Basic Laboratory Interpretation: Vitamin B12 Level - CORRECT ANSWER Deficiency
of vitamin B12 can affect mood and other brain functions
-psychiatric symptoms associated with B12 deficiency include depression, mania,
psychotic symptoms, and cognitive impairment
normal: 190-950 picograms/mL
• 200-300/mL indicates a borderline level with a possible need for additional testing
Basic Laboratory Interpretation: Vitamin D Level - CORRECT ANSWER affects
functions such as neurotransmission, neuroprotection, & neuroimmunomodulation
-high prevalence of vitamin D deficiency in clients with psychiatric disorders such as
schizophrenia, depression, seasonal affective disorder, and cognitive impairment
-Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis,
and poor brain development
25-hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a
deficiency
Basic Laboratory Interpretation: Toxicology Screen - CORRECT ANSWER -rule out
substance use as a cause for symptoms
-used before starting therapy involving controlled substances
-used to monitor medication adherence
-used in the diagnosis of substance use disorder
Basic Laboratory Interpretation: Urinalysis (UA) - CORRECT ANSWER Urinary tract
infections are associated with a variety of neuropsychiatric symptoms
-acute mental status changes
• UA may be used to rule out a UTI as the cause.
Treat or Refer:
, Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L. - CORRECT
ANSWER Refer
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with
fatigue. A referral for treatment of hypothyroidism is required. Client can be reevaluated
for fatigue if symptoms persist after hypothyroid treatment has been initiated, TSH
levels are within normal limits.
Treat or Refer:
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%. - CORRECT ANSWER Begin treatment
Rationale: The hemoglobin and hematocrit are within normal limits. This client's
complaint of fatigue is not due to anemia. Begin treatment based on a complete
evaluation.
Treat or Refer:
Terri is a 79-year old who presents with confusion. She has positive urine leukocyte
esterase. - CORRECT ANSWER Refer
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract
infection (UTI) , which may cause confusion. Refer this client for treatment of the UTI.
Treat or Refer:
Julio is a 66-year-old who presents with depression. His vitamin D level 11 ng/mL. -
CORRECT ANSWER Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP
may refer or treat vitamin D deficiency depending on the level of comfort of the provider.
Treat or Refer:
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL. - CORRECT
ANSWER Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is
associated with anxiety symptoms. Client can be reevaluated for anxiety once
hyperthyroid treatment has been initiated and T3 levels are within normal limits.
Treat or Refer:
Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900
picograms/mL. - CORRECT ANSWER Begin treatment
Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis
should be initiated.
Treat or Refer:
[ACTUAL EXAM] LATEST VERSION
[QUESTIONS AND ANSWERS] WITH
PRACTICE EXAM DETAILED AND
VERIFIED FOR GUARANTEED PASS-
LATEST UPDATE 2025 GRADED A
A 52-year-old client presents to the emergency department following a car accident.
The emergency department (ED) physician is concerned that the client may have
intentionally crashed her car and requests a stat PMHNP consult. In speaking with the
PMHNP, the client describes persistent feelings of sadness and hopelessness. She
states that she often wonders if her husband would be happier if she wasn't around
anymore since she's never happy and sometimes thinks about what it would be like to
just take a handful of sleeping pills and go to sleep forever. The client reports a previous
suicide attempt when she was 16 but denies that she is considering killing herself right
now.
Based on the client's ASQ score, what is the most appropriate response?
No action is necessary as the client is not currently considering suicide.
Provide a brief suicide safety assessment.
Alert the client's primary care physician.
Provide a ST - CORRECT ANSWER Provide a brief suicide safety assessment.
Rationale: While the client's responses do not indicate a need for a stat full safety and
mental health evaluation, the client requires a brief suicide safety assessment to
determine whether a full mental health evaluation in necessary. It is also important to
notify the client's physician or the clinician responsible for the client's care.
Diagnostic Testing when diagnosing mental health disorders - CORRECT ANSWER -
Diagnostic tests and labs are most used to rule out physical conditions that may cause
psychiatric symptoms and to evaluate the effects of treatment
Basic Laboratory Interpretation - CORRECT ANSWER Complete Blood Count
Comprehensive Metabolic Panel (CMP)
Thyroid Function Tests
Vitamin B12 Level
Vitamin D Level
,Toxicology Screen
Urinalysis (UA)
Basic Laboratory Interpretation: Complete Blood Count - CORRECT ANSWER -
measures RBCs, WBCs, hemoglobin, hematocrit, and platelets
-includes a differential of the WBCs
-In mental health, the CBC is used to rule out medical conditions that may present with
symptoms that can be attributed to both medical and psychiatric diagnoses
• Ex: rule out anemia as a cause for depressive symptoms and fatigue
• Ex: rule out infection as a cause of acute mental status changes
RBCs: 4.5-6.0 million/microliter
Hemoglobin: 12-18 grams/100 mL
Hematocrit: 38%-48%
Reticulocytes: 0%-1.5%
WBCs (total): 5000-10,000/microliter
Neutrophils: 55%-70%
Eosinophils: 1%-3%
Basophils: 0.5%-1%
Lymphocytes: 20%-35%
Monocytes: 3%-8%
Platelets: 150,000-300,000/microliter
Basic Laboratory Interpretation: Comprehensive Metabolic Panel (CMP) - CORRECT
ANSWER common blood test used to determine general health status
-fluid and electrolyte balance, status of the body's metabolism, liver function, and kidney
function
-used to monitor the effects of medications, such as antipsychotics, on liver function and
glucose levels
-rule out medical conditions that could cause symptoms
• Ex: changes in mood or cognition
Sodium (Na+): 136-145 mEq/L
Postassium (K+): 3.5-5.0 mEq/L
Chloride (Cl-): 95-105 mEq/L
Bicarbonate (HCO3-): 22-28 mEq/L
Calcium, serum (Ca 2+) 8.4-10.2 mg/dl
Glucose, serum Fasting: 70-110 mg/dl; 2-h postprandial: <120mg/dl
Cholesterol, serum: REC<200 mg/dl
Total Protein 6.0-7.8 g/dl
Albumin 3.5-5.5 g/dl
-Kidney Tests
• Creatinine, serum 0.6-1.2mg/dl
• Urea nitrogen, serum (BUN) 7-18mg/dl
-Liver Tests
• Alanine aminotransferase (ALT), serum: 8-20 U/L
,• Aspartate aminotransferase (AST), serum: 8-20 U/L
• Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl
• Phosphatase (alkaline), serum: 20-70 U/L
Basic Laboratory Interpretation: Thyroid Function Tests (TFTs) - CORRECT ANSWER
used to rule out thyroid disorders as a cause for symptoms
• symptoms related to thyroid disorders include anxiety, restlessness, depression, mood
swings, sleeping difficulties, difficulties with concentration, short-term memory lapses,
and lack of mental alertness
Normal TFT levels
TSH: 0.4-4.5 mIU/L
T3: 100-200 ng/dL
T4: 5-11 ug/dL
Basic Laboratory Interpretation: Vitamin B12 Level - CORRECT ANSWER Deficiency
of vitamin B12 can affect mood and other brain functions
-psychiatric symptoms associated with B12 deficiency include depression, mania,
psychotic symptoms, and cognitive impairment
normal: 190-950 picograms/mL
• 200-300/mL indicates a borderline level with a possible need for additional testing
Basic Laboratory Interpretation: Vitamin D Level - CORRECT ANSWER affects
functions such as neurotransmission, neuroprotection, & neuroimmunomodulation
-high prevalence of vitamin D deficiency in clients with psychiatric disorders such as
schizophrenia, depression, seasonal affective disorder, and cognitive impairment
-Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis,
and poor brain development
25-hydroxy vitamin D blood test: normal 20-50 ng/mL, less than 12 ng/mL indicates a
deficiency
Basic Laboratory Interpretation: Toxicology Screen - CORRECT ANSWER -rule out
substance use as a cause for symptoms
-used before starting therapy involving controlled substances
-used to monitor medication adherence
-used in the diagnosis of substance use disorder
Basic Laboratory Interpretation: Urinalysis (UA) - CORRECT ANSWER Urinary tract
infections are associated with a variety of neuropsychiatric symptoms
-acute mental status changes
• UA may be used to rule out a UTI as the cause.
Treat or Refer:
, Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L. - CORRECT
ANSWER Refer
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with
fatigue. A referral for treatment of hypothyroidism is required. Client can be reevaluated
for fatigue if symptoms persist after hypothyroid treatment has been initiated, TSH
levels are within normal limits.
Treat or Refer:
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%. - CORRECT ANSWER Begin treatment
Rationale: The hemoglobin and hematocrit are within normal limits. This client's
complaint of fatigue is not due to anemia. Begin treatment based on a complete
evaluation.
Treat or Refer:
Terri is a 79-year old who presents with confusion. She has positive urine leukocyte
esterase. - CORRECT ANSWER Refer
Rationale: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract
infection (UTI) , which may cause confusion. Refer this client for treatment of the UTI.
Treat or Refer:
Julio is a 66-year-old who presents with depression. His vitamin D level 11 ng/mL. -
CORRECT ANSWER Refer
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP
may refer or treat vitamin D deficiency depending on the level of comfort of the provider.
Treat or Refer:
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL. - CORRECT
ANSWER Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is
associated with anxiety symptoms. Client can be reevaluated for anxiety once
hyperthyroid treatment has been initiated and T3 levels are within normal limits.
Treat or Refer:
Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900
picograms/mL. - CORRECT ANSWER Begin treatment
Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis
should be initiated.
Treat or Refer:
