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Differential Dx - Correct Answers Diagnostic reasoning is the process of questioning one's Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
thinking to determine if all possible avenues have been explored and if the conclusions that are
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drawn are based on evidence. This is a critical step for providers who are trying to uncover a
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cause, or diagnosis, for their clients' signs and symptoms. The provider's initial hypothesis is
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known as the differential diagnosis. The differential diagnosis, or differential, is a working list of
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potential problems that can be associated with the initial or chief complaint. Establishing a
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differential diagnosis is a critical step in providing safe, quality care. This evolving process of
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clinical reasoning and decision making involves examining the client's presentation, clinical data,
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and when appropriate, screening and diagnostic test results to distinguish one disease from
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another and arrive at the correct diagnosis. The Diagnostic and Statistical Manual of Mental
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Disorders (DSM-5-TR)provides guidance for identifying psychiatric diagnosest
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Il` History of Present Illness - Correct Answers How long have you been feeling this way?
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Did something happen in your life that may have triggered these emotions?
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How is this current situation impacting your life?
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Il` The Psychiatric History - Correct Answers Have you ever been hospitalized for any mental health
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Il` issues?
Have you ever had counseling or psychotherapy?
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Have you ever taken medications for your mental health in the past?
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Are you currently on any medications for mental health or sleep?
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Il` Medical History/Screening for General Medical Conditions - Correct Answers Do you have a
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Il` primary care provider? Il` Il`
Do you have any medical illnesses?
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Are you currently taking any medications or herbal supplements?
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Do you have any allergies to medications?
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,Have you ever been hospitalized for any reason?
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Have you ever had surgery? Il` Il` Il` Il`
Il` Family Psychiatric History - Correct Answers Has any relative of yours ever been hospitalized for
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Il` a mental health issue?
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Has any blood relative of yours ever been diagnosed with a mental health issue?
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Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
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Il` Social and Developmental History - Correct Answers Tell me a little bit about your childhood and
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Il` how you grew up. Il` Il` Il`
How was your experience in school when you were younger? Did you enjoy school?
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How do you support yourself with your finances?
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Do you have a good support system? Are you currently in a relationship? Where do you live? Who
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do you live with?
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What do you do in your free time? What activities do you enjoy?
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Il` Which of the following should be included when providing client education about medication
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Il` regimens? Select all that apply. - Correct Answers A)Explain how the medication targets the Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
Il` symptoms, specific benefits, and expected time course. (Correct answer) Il` Il` Il` Il` Il` Il` Il` Il`
B)Identify potential side effects, duration of side effects, and adverse effects. (Correct answer)
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C)Explain the instructions, dosing, and special requirements. (Correct answer) Il` Il` Il` Il` Il` Il` Il` Il`
D)Use teach-back methods to ensure client understanding. (Correct answer)
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Il` Apply the Ask Suicide-Screening Questions (ASQ) Suicide Risk Screening Tool (Links to an external
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Il` site.) to the scenario below.
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A 52-year-old client presents to the emergency department following a car accident. The
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emergency department (ED) physician is concerned that the client may have intentionally crashed
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her car and requests a stat PMHNP consult. In speaking with the PMHNP, the client describes
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persistent feelings of sadness and hopelessness. She states that she often wonders if her husband
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,Il` would be happier if she wasn't around anymore since she's never happy and sometimes thinks
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Il` about what it would be like to just take a handful of sleeping pills and go to sleep forever. The
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Il` client reports a previous suicide attempt when she was 16 but denies that she is considering
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Il` killing herself right now. Il` Il` Il`
Based on the client's ASQ score, what is the most appropriate response?
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A) No action is necessary as the client is not - Correct Answers B)Provide a brief suicide safety
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assessment.
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Rationale: While the client's responses do not indicate a need for a stat full safety and mental
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health evaluation, the client requires a brief suicide safety assessment to determine whether a
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full mental health evaluation in necessary. It is also important to notify the client's physician or
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the clinician responsible for the client's care.
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Il` Complete Blood Count - Correct Answers The CBC is a serum diagnostic test that measures red
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Il` blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The CBC includes a
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Il` differential of the white blood cells. A CBC is often included as part of routine health screening or
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Il` to obtain information related to specific conditions. In mental health, the CBC is used to rule out
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Il` medical conditions that may present with symptoms that can be attributed to both medical and
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Il` psychiatric diagnoses. For example, the CBC can help rule out anemia as a cause for depressive
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Il` symptoms and fatigue or rule out infection as a cause of acute mental status changes. The CBC is
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Il` also used to monitor certain treatment regimens. For example, some medications, such as
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Il` clozapine, require routine analysis of absolute neutrophil count and platelet levels.
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Il` Normal Range of: Il` Il` Il`
Red blood cells Il` Il`
Hemoglobin
Hematocrit
Reticulocytes - Correct Answers Red blood cells: 4.5-6.0 million/microliter Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
Hemoglobin: 12-18 grams/100 mL Il` Il` Il`
Hematocrit: 38%-48% Il`
Reticulocytes: 0%-1.5% Il`
, Il` Normal Range of? Il` Il` Il`
White blood cells (total): Il` Il` Il` Il`
Neutrophils: Il`
Eosinophils: Il`
Basophils: Il`
Lymphocytes: Il`
Monocytes: Il`
Platelets: - Correct Answers White blood cells (total): 5000-10,000/microliter
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Neutrophils: 55%-70% Il`
Eosinophils: 1%-3% Il`
Basophils: 0.5%-1% Il`
Lymphocytes: 20%-35% Il`
Monocytes: 3%-8% Il`
Platelets: 150,000-300,000/microliter Il`
Il` Comprehensive Metabolic Panel (CMP) - Correct Answers The CMP is another common blood Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
Il` test used to determine general health status. The CMP includes several tests that provide
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Il` information about fluid and electrolyte balance as well as the status of the body's metabolism,
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Il` liver function, and kidney function. In psychiatric care, the CMP may be used to rule out medical
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Il` conditions that could cause symptoms such as changes in mood or cognition. The CMP is also
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Il` used to monitor the effects of medications, such as antipsychotics, on liver function and glucose
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Il` levels.
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Electrolytes
Sodium (Na+): Il` Il`
Postassium (K+): Il` Il`