NR 547 DIFFERENTIAL DX MIDTERM
Differential44Dx44-44answer--
Diagnostic44reasoning44is44the44process44of44questioning44one's44thinking44to44determin
e44if44all44possible44avenues44have44been44explored44and44if44the44conclusions44that44ar
e44drawn44are44based44on44evidence.44This44is44a44critical44step44for44providers44who44a
re44trying44to44uncover44a44cause,44or44diagnosis,44for44their44clients'44signs44and44symp
toms.44The44provider's44initial44hypothesis44is44known44as44the44differential44diagnosis.44
The44differential44diagnosis,44or44differential,44is44a44working44list44of44potential44problem
s44that44can44be44associated44with44the44initial44or44chief44complaint.44Establishing44a44d
ifferential44diagnosis44is44a44critical44step44in44providing44safe,44quality44care.44This44evo
lving44process44of44clinical44reasoning44and44decision44making44involves44examining44th
e44client's44presentation,44clinical44data,44and44when44appropriate,44screening44and44dia
gnostic44test44results44to44distinguish44one44disease44from44another44and44arrive44at44th
e44correct44diagnosis.44The44Diagnostic44and44Statistical44Manual44of44Mental44Disorder
s44(DSM-5-TR)provides44guidance44for44identifying44psychiatric44diagnosest
History44of44Present44Illness44-44answer--
How44long44have44you44been44feeling44this44way?
Did44something44happen44in44your44life44that44may44have44triggered44these44emotions?
How44is44this44current44situation44impacting44your44life?
The44Psychiatric44History44-44answer--
Have44you44ever44been44hospitalized44for44any44mental44health44issues?
Have44you44ever44had44counseling44or44psychotherapy?
Have44you44ever44taken44medications44for44your44mental44health44in44the44past?
Are44you44currently44on44any44medications44for44mental44health44or44sleep?
Medical44History/Screening44for44General44Medical44Conditions44-44answer--
Do44you44have44a44primary44care44provider?
Do44you44have44any44medical44illnesses?
Are44you44currently44taking44any44medications44or44herbal44supplements?
Do44you44have44any44allergies44to44medications?
Have44you44ever44been44hospitalized44for44any44reason?
Have44you44ever44had44surgery?
,Family44Psychiatric44History44-44answer--
Has44any44relative44of44yours44ever44been44hospitalized44for44a44mental44health44issue?
Has44any44blood44relative44of44yours44ever44been44diagnosed44with44a44mental44health44
issue?
Has44any44blood44relative44of44yours44had44a44history44of44seizures44or44dementia/
Alzheimer's?
Social44and44Developmental44History44-44answer--
Tell44me44a44little44bit44about44your44childhood44and44how44you44grew44up.
How44was44your44experience44in44school44when44you44were44younger?
44Did44you44enjoy44school?
How44do44you44support44yourself44with44your44finances?
Do44you44have44a44good44support44system?44Are44you44currently44in44a44relationship?
44Where44do44you44live?44Who44do44you44live44with?
What44do44you44do44in44your44free44time?44What44activities44do44you44enjoy?
Which44of44the44following44should44be44included44when44providing44client44education44a
bout44medication44regimens?44Select44all44that44apply.44-44answer--
A)Explain44how44the44medication44targets44the44symptoms,44specific44benefits,44and44ex
pected44time44course.44(Correct44answer)
B)Identify44potential44side44effects,44duration44of44side44effects,44and44adverse44effects.4
4(Correct44answer)
C)Explain44the44instructions,44dosing,44and44special44requirements.44(Correct44answer)
D)Use44teach-back44methods44to44ensure44client44understanding.44(Correct44answer)
Apply44the44Ask44Suicide-
Screening44Questions44(ASQ)44Suicide44Risk44Screening44Tool44(Links44to44an44externa
l44site.)44to44the44scenario44below.
A4452-year-
old44client44presents44to44the44emergency44department44following44a44car44accident.44Th
e44emergency44department44(ED)44physician44is44concerned44that44the44client44may44ha
ve44intentionally44crashed44her44car44and44requests44a44stat44PMHNP44consult.44In44spe
aking44with44the44PMHNP,44the44client44describes44persistent44feelings44of44sadness44a
nd44hopelessness.44She44states44that44she44often44wonders44if44her44husband44would44
be44happier44if44she44wasn't44around44anymore44since44she's44never44happy44and44som
etimes44thinks44about44what44it44would44be44like44to44just44take44a44handful44of44sleeping
44pills44and44go44to44sleep44forever.44The44client44reports44a44previous44suicide44attempt
44when44she44was441644but44denies44that44she44is44considering44killing44herself44right44n
ow.
Based44on44the44client's44ASQ44score,44what44is44the44most44appropriate44response?
A)44No44action44is44necessary44as44the44client44is44not44-44answer--
B)Provide44a44brief44suicide44safety44assessment.44
Rationale:44While44the44client's44responses44do44not44indicate44a44need44for44a44stat44ful
l44safety44and44mental44health44evaluation,44the44client44requires44a44brief44suicide44safe
ty44assessment44to44determine44whether44a44full44mental44health44evaluation44in44neces
,sary.44It44is44also44important44to44notify44the44client's44physician44or44the44clinician44resp
onsible44for44the44client's44care.
Complete44Blood44Count44-44answer--
The44CBC44is44a44serum44diagnostic44test44that44measures44red44blood44cells,44white44bl
ood44cells,44hemoglobin,44hematocrit,44and44platelets.44The44CBC44includes44a44differen
tial44of44the44white44blood44cells.44
A44CBC44is44often44included44as44part44of44routine44health44screening44or44to44obtain44in
formation44related44to44specific44conditions.44In44mental44health,44the44CBC44is44used44t
o44rule44out44medical44conditions44that44may44present44with44symptoms44that44can44be44
attributed44to44both44medical44and44psychiatric44diagnoses.44For44example,44the44CBC44
can44help44rule44out44anemia44as44a44cause44for44depressive44symptoms44and44fatigue4
4or44rule44out44infection44as44a44cause44of44acute44mental44status44changes.44The44CBC
44is44also44used44to44monitor44certain44treatment44regimens.44For44example,44some44me
dications,44such44as44clozapine,44require44routine44analysis44of44absolute44neutrophil44c
ount44and44platelet44levels.
Normal44Range44of:44
Red44blood44cells
Hemoglobin
Hematocrit
Reticulocytes44-44answer--Red44blood44cells:444.5-6.044million/microliter
Hemoglobin:4412-1844grams/10044mL
Hematocrit:4438%-48%
Reticulocytes:440%-1.5%
Normal44Range44of?44
White44blood44cells44(total):44
Neutrophils:44
Eosinophils:44
Basophils:44
Lymphocytes:44
Monocytes:44
Platelets:44-44answer--White44blood44cells44(total):445000-10,000/microliter
Neutrophils:4455%-70%
Eosinophils:441%-3%
Basophils:440.5%-1%
Lymphocytes:4420%-35%
Monocytes:443%-8%
Platelets:44150,000-300,000/microliter
Comprehensive44Metabolic44Panel44(CMP)44-44answer--
The44CMP44is44another44common44blood44test44used44to44determine44general44health44s
tatus.44The44CMP44includes44several44tests44that44provide44information44about44fluid44an
d44electrolyte44balance44as44well44as44the44status44of44the44body's44metabolism,44liver44f
unction,44and44kidney44function.44In44psychiatric44care,44the44CMP44may44be44used44to44
, rule44out44medical44conditions44that44could44cause44symptoms44such44as44changes44in44
mood44or44cognition.44The44CMP44is44also44used44to44monitor44the44effects44of44medicat
ions,44such44as44antipsychotics,44on44liver44function44and44glucose44levels.
Normal44CMP44Levels
Electrolytes
Sodium44(Na+):44
Postassium44(K+):44
Chloride44(Cl-):44
Bicarbonate44(HCO3-):44-44answer--Normal44CMP44Levels
Electrolytes
Sodium44(Na+):44136-14544mEq/L
Postassium44(K+):443.5-5.044mEq/L
Chloride44(Cl-):4495-10544mEq/L
Bicarbonate44(HCO3-):4422-2844mEq/L
Normal44CMP44levels
Misc.44
Calcium,44serum44(Ca442+)44
Glucose,44serum44Fasting:44
2-h44postprandial:44
Cholesterol,44serum:
Total44Protein
Albumin44-44answer--Calcium,44serum44(Ca442+)448.4-10.244mg/dl
Glucose,44serum44Fasting:4470-11044mg/dl;
442-h44postprandial:44<120mg/dl
Cholesterol,44serum:44REC<20044mg/dl
Total44Protein446.0-7.844g/dl
Albumin443.5-5.544g/dl
Kidney44Tests
Creatinine,44serum44
Urea44nitrogen,44serum44(BUN)44-44answer--Creatinine,44serum440.6-1.2mg/dl
Urea44nitrogen,44serum44(BUN)447-18mg/dl
Liver44Tests
Alanine44aminotransferase44(ALT),44serum:44
Aspartate44aminotransferase44(AST),44
Bilirubin,44serum44(adult)44Total//Direct:44
Phosphatase44(alkaline),44serum:44-44answer--Liver44Tests
Alanine44aminotransferase44(ALT),44serum:448-2044U/L
Aspartate44aminotransferase44(AST),44serum:448-2044U/L
Bilirubin,44serum44(adult)44Total//Direct:440.1-1.044mg/dl44//440.0-0.344mg/dl
Phosphatase44(alkaline),44serum:4420-7044U/L
Normal44TFT44levels
Differential44Dx44-44answer--
Diagnostic44reasoning44is44the44process44of44questioning44one's44thinking44to44determin
e44if44all44possible44avenues44have44been44explored44and44if44the44conclusions44that44ar
e44drawn44are44based44on44evidence.44This44is44a44critical44step44for44providers44who44a
re44trying44to44uncover44a44cause,44or44diagnosis,44for44their44clients'44signs44and44symp
toms.44The44provider's44initial44hypothesis44is44known44as44the44differential44diagnosis.44
The44differential44diagnosis,44or44differential,44is44a44working44list44of44potential44problem
s44that44can44be44associated44with44the44initial44or44chief44complaint.44Establishing44a44d
ifferential44diagnosis44is44a44critical44step44in44providing44safe,44quality44care.44This44evo
lving44process44of44clinical44reasoning44and44decision44making44involves44examining44th
e44client's44presentation,44clinical44data,44and44when44appropriate,44screening44and44dia
gnostic44test44results44to44distinguish44one44disease44from44another44and44arrive44at44th
e44correct44diagnosis.44The44Diagnostic44and44Statistical44Manual44of44Mental44Disorder
s44(DSM-5-TR)provides44guidance44for44identifying44psychiatric44diagnosest
History44of44Present44Illness44-44answer--
How44long44have44you44been44feeling44this44way?
Did44something44happen44in44your44life44that44may44have44triggered44these44emotions?
How44is44this44current44situation44impacting44your44life?
The44Psychiatric44History44-44answer--
Have44you44ever44been44hospitalized44for44any44mental44health44issues?
Have44you44ever44had44counseling44or44psychotherapy?
Have44you44ever44taken44medications44for44your44mental44health44in44the44past?
Are44you44currently44on44any44medications44for44mental44health44or44sleep?
Medical44History/Screening44for44General44Medical44Conditions44-44answer--
Do44you44have44a44primary44care44provider?
Do44you44have44any44medical44illnesses?
Are44you44currently44taking44any44medications44or44herbal44supplements?
Do44you44have44any44allergies44to44medications?
Have44you44ever44been44hospitalized44for44any44reason?
Have44you44ever44had44surgery?
,Family44Psychiatric44History44-44answer--
Has44any44relative44of44yours44ever44been44hospitalized44for44a44mental44health44issue?
Has44any44blood44relative44of44yours44ever44been44diagnosed44with44a44mental44health44
issue?
Has44any44blood44relative44of44yours44had44a44history44of44seizures44or44dementia/
Alzheimer's?
Social44and44Developmental44History44-44answer--
Tell44me44a44little44bit44about44your44childhood44and44how44you44grew44up.
How44was44your44experience44in44school44when44you44were44younger?
44Did44you44enjoy44school?
How44do44you44support44yourself44with44your44finances?
Do44you44have44a44good44support44system?44Are44you44currently44in44a44relationship?
44Where44do44you44live?44Who44do44you44live44with?
What44do44you44do44in44your44free44time?44What44activities44do44you44enjoy?
Which44of44the44following44should44be44included44when44providing44client44education44a
bout44medication44regimens?44Select44all44that44apply.44-44answer--
A)Explain44how44the44medication44targets44the44symptoms,44specific44benefits,44and44ex
pected44time44course.44(Correct44answer)
B)Identify44potential44side44effects,44duration44of44side44effects,44and44adverse44effects.4
4(Correct44answer)
C)Explain44the44instructions,44dosing,44and44special44requirements.44(Correct44answer)
D)Use44teach-back44methods44to44ensure44client44understanding.44(Correct44answer)
Apply44the44Ask44Suicide-
Screening44Questions44(ASQ)44Suicide44Risk44Screening44Tool44(Links44to44an44externa
l44site.)44to44the44scenario44below.
A4452-year-
old44client44presents44to44the44emergency44department44following44a44car44accident.44Th
e44emergency44department44(ED)44physician44is44concerned44that44the44client44may44ha
ve44intentionally44crashed44her44car44and44requests44a44stat44PMHNP44consult.44In44spe
aking44with44the44PMHNP,44the44client44describes44persistent44feelings44of44sadness44a
nd44hopelessness.44She44states44that44she44often44wonders44if44her44husband44would44
be44happier44if44she44wasn't44around44anymore44since44she's44never44happy44and44som
etimes44thinks44about44what44it44would44be44like44to44just44take44a44handful44of44sleeping
44pills44and44go44to44sleep44forever.44The44client44reports44a44previous44suicide44attempt
44when44she44was441644but44denies44that44she44is44considering44killing44herself44right44n
ow.
Based44on44the44client's44ASQ44score,44what44is44the44most44appropriate44response?
A)44No44action44is44necessary44as44the44client44is44not44-44answer--
B)Provide44a44brief44suicide44safety44assessment.44
Rationale:44While44the44client's44responses44do44not44indicate44a44need44for44a44stat44ful
l44safety44and44mental44health44evaluation,44the44client44requires44a44brief44suicide44safe
ty44assessment44to44determine44whether44a44full44mental44health44evaluation44in44neces
,sary.44It44is44also44important44to44notify44the44client's44physician44or44the44clinician44resp
onsible44for44the44client's44care.
Complete44Blood44Count44-44answer--
The44CBC44is44a44serum44diagnostic44test44that44measures44red44blood44cells,44white44bl
ood44cells,44hemoglobin,44hematocrit,44and44platelets.44The44CBC44includes44a44differen
tial44of44the44white44blood44cells.44
A44CBC44is44often44included44as44part44of44routine44health44screening44or44to44obtain44in
formation44related44to44specific44conditions.44In44mental44health,44the44CBC44is44used44t
o44rule44out44medical44conditions44that44may44present44with44symptoms44that44can44be44
attributed44to44both44medical44and44psychiatric44diagnoses.44For44example,44the44CBC44
can44help44rule44out44anemia44as44a44cause44for44depressive44symptoms44and44fatigue4
4or44rule44out44infection44as44a44cause44of44acute44mental44status44changes.44The44CBC
44is44also44used44to44monitor44certain44treatment44regimens.44For44example,44some44me
dications,44such44as44clozapine,44require44routine44analysis44of44absolute44neutrophil44c
ount44and44platelet44levels.
Normal44Range44of:44
Red44blood44cells
Hemoglobin
Hematocrit
Reticulocytes44-44answer--Red44blood44cells:444.5-6.044million/microliter
Hemoglobin:4412-1844grams/10044mL
Hematocrit:4438%-48%
Reticulocytes:440%-1.5%
Normal44Range44of?44
White44blood44cells44(total):44
Neutrophils:44
Eosinophils:44
Basophils:44
Lymphocytes:44
Monocytes:44
Platelets:44-44answer--White44blood44cells44(total):445000-10,000/microliter
Neutrophils:4455%-70%
Eosinophils:441%-3%
Basophils:440.5%-1%
Lymphocytes:4420%-35%
Monocytes:443%-8%
Platelets:44150,000-300,000/microliter
Comprehensive44Metabolic44Panel44(CMP)44-44answer--
The44CMP44is44another44common44blood44test44used44to44determine44general44health44s
tatus.44The44CMP44includes44several44tests44that44provide44information44about44fluid44an
d44electrolyte44balance44as44well44as44the44status44of44the44body's44metabolism,44liver44f
unction,44and44kidney44function.44In44psychiatric44care,44the44CMP44may44be44used44to44
, rule44out44medical44conditions44that44could44cause44symptoms44such44as44changes44in44
mood44or44cognition.44The44CMP44is44also44used44to44monitor44the44effects44of44medicat
ions,44such44as44antipsychotics,44on44liver44function44and44glucose44levels.
Normal44CMP44Levels
Electrolytes
Sodium44(Na+):44
Postassium44(K+):44
Chloride44(Cl-):44
Bicarbonate44(HCO3-):44-44answer--Normal44CMP44Levels
Electrolytes
Sodium44(Na+):44136-14544mEq/L
Postassium44(K+):443.5-5.044mEq/L
Chloride44(Cl-):4495-10544mEq/L
Bicarbonate44(HCO3-):4422-2844mEq/L
Normal44CMP44levels
Misc.44
Calcium,44serum44(Ca442+)44
Glucose,44serum44Fasting:44
2-h44postprandial:44
Cholesterol,44serum:
Total44Protein
Albumin44-44answer--Calcium,44serum44(Ca442+)448.4-10.244mg/dl
Glucose,44serum44Fasting:4470-11044mg/dl;
442-h44postprandial:44<120mg/dl
Cholesterol,44serum:44REC<20044mg/dl
Total44Protein446.0-7.844g/dl
Albumin443.5-5.544g/dl
Kidney44Tests
Creatinine,44serum44
Urea44nitrogen,44serum44(BUN)44-44answer--Creatinine,44serum440.6-1.2mg/dl
Urea44nitrogen,44serum44(BUN)447-18mg/dl
Liver44Tests
Alanine44aminotransferase44(ALT),44serum:44
Aspartate44aminotransferase44(AST),44
Bilirubin,44serum44(adult)44Total//Direct:44
Phosphatase44(alkaline),44serum:44-44answer--Liver44Tests
Alanine44aminotransferase44(ALT),44serum:448-2044U/L
Aspartate44aminotransferase44(AST),44serum:448-2044U/L
Bilirubin,44serum44(adult)44Total//Direct:440.1-1.044mg/dl44//440.0-0.344mg/dl
Phosphatase44(alkaline),44serum:4420-7044U/L
Normal44TFT44levels
