NR547 Midterm Exam 2025/2026 Updated | Real
Questions with Correct Answers
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
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
-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
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
,-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)
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)
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
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
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
-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)
, 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.
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%.
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.
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.
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.
Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated
Questions with Correct Answers
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
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
-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
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
,-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)
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)
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
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
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
-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)
, 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.
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%.
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.
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.
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.
Refer
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated
